When HIV infection is preferable to pregnancy

Does PrEP work in women?

If you'd asked that question a few years ago, the answer from many quarters would have been no--but not because the medicine, and HIV drug sold by Gilead at Truvada, doesn't prevent transmission. It was because, in two studies of African women called VOICE and FEM PrEP, women didn't take the medicine.

"What we need to know," Gina Brown at the NIH told me for an upcoming article, "is why they didn't take the drug. What else is going on? It could be as simple as, 'Were they afraid of the side effects?' Or it could be as complex as, 'They didn't want to be seen taking HIV drugs.'"

Or it could be more complicated, by how much power single women feel they have in their relationships, and how much pressure they receive from their cultures to be sexy but not sexual. That is, now much does sexism and slut-shaming effect women's willingness to look after their own health.

Today, I got a piece of that answer, at an AVAC-sponsored webcast on women, PrEP and HIV prevention. On the webcast were researchers from VOICE and other trials, picking through their data and qualitative interviews on why women who would sign up for an HIV prevention trial would then NOT take the medicine.

This slide, shared by Moushira El-Sahn of the international research firm Ipsos, laid out one of the reasons, perhaps, that women don't advocate for their health: They'd rather get HIV than get pregnant.


Let me emphasize: You can't see HIV anymore. But you can see pregnancy. 

This tells us a lot, I think, about what it means to help women protect themselves from HIV. And it reminds me of an article I did several years ago for The San Francisco Chronicle Sunday Magazine. That article, on the advent of the HPV vaccine, posited that this generation of girls had the potential to be the most sexually healthy in history. We have the technology.

But what it found was that cultural norms that make women's sexuality a political football also made it harder for women to take care of their health.

I'm posting this here, even though Positively Negative is about couples who want both to have babies and to prevent the transmission of HIV. I think it's important to put the book and the couples in context. It seems that being part of a loving partnership in which keeping the woman HIV-negative is a key piece in women's sexual health and overall health.

What do you think? If you had to choose, would you choose HIV or pregnancy?