This article highlights the alarming rise in HIV infections among women, particularly young women and women over 50, emphasizing the need for targeted prevention strategies and accessible healthcare. It explores the barriers hindering widespread adoption of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) among women, including misconceptions, lack of awareness, inadequate healthcare guidance, and socioeconomic factors. The article also discusses promising advancements in prophylactic options, such as long-acting injectable cabotegravir and the dapivirine vaginal ring, which offer hope for more effective HIV prevention.
The COVID-19 pandemic has significantly exacerbated the HIV epidemic, particularly among young women. According to the Ministry of Health 's HIV and AIDS Epidemiological Bulletin published in December 2024, there were 125,753 reported cases of HIV among young people aged 15-24 years between 2013 and 2023, representing 23.2% of the national total. Of these patients, 24.8% were men and 19.
4% were women, highlighting the urgent need for public policies on prevention, early diagnosis, and accessible treatment for this age group. Another concern is the increase in HIV infections among women over 50 years of age. In this age group, the proportion of women increased from 12.8% in 2013 to 21.1% in 2023, whereas the proportion of men increased from 9% to 12%. These findings indicate the need for strategies that address the specific needs of women at different stages of life, including prophylaxis, early detection, and prevention of HIV transmission in infants.Despite these alarming figures, awareness of and access to preventive measures, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), remain limited among women and healthcare professionals. One major challenge is the misperception of personal risk. Studies conducted in the United States found that only 37.5% of participants initially expressed interest in PrEP. After educational sessions on medication, this number dropped to 2.8%, revealing that underestimating risk is a critical obstacle to adopting preventive measures. Another study conducted in the United States found that only one third of the women were aware of prophylaxis, although many expressed interest when informed. This lack of awareness is worsened by the absence of targeted educational campaigns and the stigma associated with medication. In a 2017 study of 597 women at family planning clinics, 37% associated PrEP use with promiscuity, and 32% believed it was a sign of HIV status. These misconceptions discourage open discussions with healthcare providers and contribute to the spread of misinformation. Another significant challenge is the lack of proper guidance from healthcare professionals. Many providers are hesitant to prescribe PrEP because of inadequate training or unfamiliarity with guidelines. Furthermore, in another study, negative interactions with healthcare providers were identified as a major reason for discontinuing prophylaxis. This highlights the need for ongoing professional education and more sensitive and consistent follow-up for patients. Socioeconomic and structural barriers further affect adherence to PrEP. Other factors include high costs, a lack of insurance coverage, and limited access to medical services. A study conducted in South Africa, including women with higher education, found that social judgment and relationship dynamics often hinder access to PrEP. These challenges are not confined to one region and require an integrated, sensitive approach to promote prevention and care.The development of prophylactic options offers hope for tackling the epidemic more effectively. In addition to the traditional oral routes, new alternatives are emerging to improve adherence and reduce stigma. Researchers have discussed new approaches to HIV prophylaxis for women, marking a significant step in a previously neglected field. These advancements include technological and pharmaceutical innovations aimed at increasing adherence; improving efficacy; and overcoming social, cultural, and logistical barriers. One of the most promising options is long-acting injectable cabotegravir, an antiretroviral medication that has proven to be superior to the oral combination of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC). Clinical studies have shown that cabotegravir administered every 2 months significantly lowers the risk for HIV infection. This option provides greater discretion and convenience, which are essential for women who face challenges with the use of daily pills because of stigma and complex social dynamics. Another innovative alternative is the dapivirine vaginal ring, which has been approved by the World Health Organization. The monthly use of this device is a highly effective preventive tool, particularly for individuals with greater social vulnerability or limited access to medical care. Studies have shown that the ring can reduce HIV incidence by up to 62% and is well tolerated and widely accepted by patients. Subdermal implants have also been explored for sustained release of antiretrovirals. These devices have the potential to provide continuous protection for several months, minimizing the need for frequent medical follow-ups and increasing women’s autonomy over their sexual health
HIV AIDS Women's Health Prophylaxis Prep PEP Prevention Healthcare Access Stigma Discrimination Public Policy Healthcare Innovations
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