What Folks With Vulvas Should Know About PrEP

Illustration by Yazmin Butcher

by Gabrielle Kassel

Many vulva-owners take birth control to reduce the risk of pregnancy and Vitamin C to avoid catching a cold. So why aren’t more folks with vulvas taking PrEP (“pre-exposure prophylaxis”), a prescription medication HIV-negative people can take to reduce the risk of contracting HIV? Experts hypothesize it’s because the drug typically marketed for gay men. However, it can be prescribed to and taken by folks of any gender, sex, or sexuality. 

In fact, people with vulvas make up 23% of people living with HIV and 19% of new HIV cases each year. “Folks with vulvas need to be better educated about the benefits of taking PrEP,” says Dr. Courtney Sherman, a nurse practitioner who works with Nurx, an online sexual health platform. PrEP isn't recommended for everyone—the risk of exposure needs to be high for it to be worth it—but here’s what vulva-havers need to know about this life-saving drug.

HIV is transmitted through the bodily fluids—blood, vaginal fluid, semen, rectal fluids, and breast milk—of an individual who has tested positive for HIV. Transmission is possible when any of these fluids come into contact with your blood, or your oral, anal, or vaginal mucous membranes. Receptive anal sex has the highest risk of transmission: “Penis-in-ass sex can cause trauma and microtears to the anal canal, and so do preparatory acts such as anal douching,” explains Dr. Evan Goldstein, CEO and founder of Bespoke Surgical, which specializes in helping men and women engage anally. Those tears increase the transmission rate when an HIV-negative person is anally penetrated by a person living with HIV. 

But anal sex isn’t the only sex act that puts you at risk for transmission. “People with vulvas can get HIV during penis-in-vagina sex, too,” says Dr. Alexea M. Gaffney, a doctor of internal medicine and infectious diseases. “That’s because the vagina is an absorbent mucous membrane.” Oral sex is deemed a low risk, but HIV can also be spread through shared needles. 

“Folks with vulvas need to be better educated about to the benefits of taking PrEP.

Using condoms consistently and correctly can help prevent transmission, but condoms’ effectiveness at eliminating HIV transmission ranges broadly from 94% all the way down to 69%, says sex and relationship expert Jamie LeClaire. That’s because “condoms are so often used incorrectly and even with proper use they can still break, slip, or leak.” Only about 30% of Americans report actually using them during sex. Many experts agree that relying on condoms to prevent against HIV transmission is not enough. 

That’s where PrEP comes in. 

Sold under the brand name Truvada, the drug is composed of two antiretroviral drugs: 200mg of emtricitabine and 300mg tenofovir disoproxil fumarate. Taken once every day, it blocks an enzyme that the HIV virus uses to replicate itself. If the virus cannot multiply itself, it cannot infect the exposed individual, which allows them to remain HIV-negative even if they come into contact with the infection. 

According to Dr. Goldstein, data shows that those who take PrEP have a 90 to 92% decreased chance of an HIV infection. “Some new info says it may even be up to 99% effective,” he says. 

So is PrEP right for you? Dr. Gaffney says if you’re a person with a vulva who has multiple sexual partners or engages in sexual intercourse with a partner who has multiple partners; does not know your sexual partners’ (and their partners’) HIV status; is in a relationship with an HIV positive person; is a victim of domestic violence; uses condoms inconsistently; or engages in sex under the influence of drugs or alcohol, then you’re at risk for HIV infection and are a good candidate for PrEP. 

Dr. Sophia Yen, CEO/co-founder of Pandia Health, is more hesitant to prescribe the drug to vulva-havers: "The CDC only recommends PrEP in those with vulvas who have regular sex with those with known HIV. Otherwise, the risks/costs outweigh the benefits."

Because an individual must be HIV-negative and have normal kidney function to be prescribed PrEP therapy, you’ll have to undergo an HIV screening and get some blood work done before your provider can prescribe the medicine. If everything comes back negative, it’s standard to be prescribed a three-month supply. 

While the drug can be very, very expensive at retail cost, PrEP is covered by most insurance plans. And if you don't have insurance or need additional financial assistance with copays, there are other options such as signing up for the Gilead Advancing Access program or any of the programs on this list, or using Nurx

Interested in learning more about PrEP or think you’re at risk of contracting HIV? Talk with your healthcare provider. Because as Dr. Goldstein says, “Knowledge and preventative sexual healthcare, like PrEP, is a great way for everybody and every body to responsibly engage sexually the way they want.”

Gabrielle Kassel is a New York-based sex and wellness writer and CrossFit Level 1 Trainer. When she’s not testing sex toys, Tindering in public, or asking folks about their sex lives (all in the name of journalism, of course) she can be found reading self-help books, bench-pressing, or pole dancing.