HIV PrEP and cisgender women: Are we meeting their needs?

Despite its proven effectiveness among all genders, awareness of HIV pre-exposure prophylaxis (PrEP) remains low among women in Canada, with lower awareness reported among cisgender women. Some key populations with higher HIV incidence have received promotion of PrEP since it was first introduced, but cis women haven’t always benefitted from the same efforts. One possible reason may be that – at least in Canada – the largest burden of HIV incidence among cis women tends to be concentrated within subsets of this population: African, Caribbean and Black women, Indigenous women, and women who inject drugs, for example. The more intersections, the more targeted and tailored the programs need to be in order to be effective.

To better understand the barriers and opportunities for PrEP uptake among cis women, CATIE spoke with 10 health and social service providers in Saskatchewan, Manitoba, Ontario and Quebec. Participants were identified through CATIE’s network and selected based on their experience prescribing or discussing PrEP with cis women. While not necessarily representative of everyone’s experience, their insights offer valuable perspectives on cis women’s needs.

What are they hearing from women?

Participants shared that cis women who may benefit from PrEP are often unaware that it even exists. Once they learn about it, many have questions about how to take it, whether it interacts with birth control, who can prescribe it and how much it costs. Once they understood its relevance, most of the cis women they served were open to learning more. Still, providers acknowledged that these conversations can be difficult because sex remains a taboo subject.

Service provider barriers

Awareness is just the first step. In order to access PrEP, eligible cis women must have a healthcare provider who is willing and able to prescribe it. The healthcare providers that we spoke with noted that awareness of the benefits of PrEP for cis women is slowly growing among their colleagues, but they also think overall knowledge remains low. Encouragingly, many mentioned that there is increased interest among their colleagues, especially among younger healthcare providers and those working in sexual health. They suggested that this may be because younger healthcare providers have more recent medical training, which likely included updated knowledge about HIV prevention (specifically, PrEP and treatment as prevention).

The non-clinical service providers that we spoke with shared that often their peers may not feel comfortable discussing HIV PrEP with service users because of a lack of knowledge about the ins and outs of the medication. They highlighted the need for accurate information about PrEP designed to support non-clinical service providers. 

What discourages cis women from considering HIV PrEP?

Participants shared several barriers to PrEP use among cis women:

• Stigma: Some cis women fear being labelled promiscuous if they take HIV PrEP. For those experiencing intimate partner violence, this is also linked to safety concerns.
• Systemic harms: Some cis women may worry that HIV PrEP could lead to negative consequences like child apprehension, due to past experiences with racism in health and social systems.
• Missed opportunities: HIV PrEP is sometimes only discussed in sexual health services but not in routine care such as reproductive health appointments, putting the onus on cis women to seek out PrEP rather than have it offered.
• Practical barriers: Heavy caseloads for service providers and time constraints limit the conversations they can have with patients and service users beyond the main reason for the appointment.

Participants in Saskatchewan and Manitoba reported there are a limited number of healthcare providers willing to prescribe HIV PrEP, even though it is free of charge in these provinces. Ontario participants were more likely to cite cost as a barrier, as the province’s public drug plan charges deductibles for HIV PrEP.

What encourages cis women to consider HIV PrEP?

Participants highlighted several strategies that make HIV PrEP more appealing to women:

• Emphasize empowerment: Shift the language from “risk” and “promiscuity” to choice and control. Talk about the power that HIV PrEP can offer over their own sexual health, especially in situations where negotiating condom use may be unsafe.
• Normalize conversations: Bring up HIV PrEP during routine visits, STI testing or outreach activities to help reduce stigma and keep the option visible. Use culturally relevant messaging that helps women understand the benefits.
• Revisit the discussion: Women’s circumstances change over time, so check in regularly about their interest in HIV PrEP.
• Expand options: Talk about related options like post-exposure prophylaxis (PEP) and PEP-in-Pocket (PIP), support condom use and harm reduction, educate about treatment as prevention, and support them to choose what fits best. Learn whether these options are available where you are, and work to make them more accessible to all women.
• Keep learning: PrEP knowledge is constantly evolving, and newer long-acting formulations are starting to roll out. The more you know about HIV PrEP, the more comfortable you will feel discussing it with service users.

HIV PrEP can be a powerful prevention tool for cis women when their healthcare and service providers feel equipped to talk about it, and when they feel safe and supported in choosing it. Let’s ensure people of all genders have the information and support they need to make informed choices about PrEP.

Sugandhi del Canto was the associate director for HIV and sexual health knowledge mobilization at CATIE from 2022 to 2025. She has since returned to her “research nerd roots” in Saskatchewan.