Provider Alert: Rise in HIV among cisgender women

Actions requested

• Promote routine HIV screening

  Integrate HIV testing into routine care, including for sexually active cisgender women, regardless of perceived risk factors. CDC recommends all individuals be tested for HIV at least once in their lifetime. In people without risk factors for HIV infection, such testing should ideally occur when people are in their late 20s or 30s (Raoet al. STD, 2020). People who move to King County from regions where the prevalence of HIV in the general population is substantially higher that in the US (such as Eastern and Southern Africa, parts of Eastern Europe) should be tested as soon as possible following their arrival in the United States. PHSKC recommends that people with the following risk factors be tested at least annually:

  • Injection drug use or use of methamphetamine or nonprescription opioids
  • Homelessness or unstable housing
  • Any transactional sex since their last HIV test
  • Persons entering correctional facilities or with a history of incarceration in the prior two years
  • Anal or vaginal sex with someone who is HIV positive since their last HIV negative test,
  • History of syphilis in the prior two years
  • Diagnosis with or treatment for another sexually transmitted infection, viral hepatitis, or tuberculosis (TB)
  • Sex with a man who has male sex partners
  • Sex with someone with any of the above risk factors

  The above risks are also risk factors for syphilis, and PHSKC recommends that medical providers test patients for both HIV and syphilis at the same time.

• Discuss Pre-Exposure Prophylaxis (PrEP)

  When taken as prescribed, PrEP reduces the risk of acquiring HIV through sex by approximately 99%. Complete local PrEP Implementation Guidelines are available (220 KB). Medical providers should recommend PrEP to all persons, including cisgender women, in ongoing sexual relationships with a partner living with HIV who is not on antiretroviral therapy (ART), OR is on ART but is not virologically suppressed OR who is within 2 months of initiating ART.
  
  Medical providers should discuss initiating PrEP with any person seeking a prescription for PrEP or based on any of the following risks:

  1. Diagnosis with syphilis in the prior two years
  2. Use of injection drugs and/or methamphetamine or opioids that are not prescribed by a medical provider
  3. Exchange of sex for money, drugs, or anything else of value, such as shelter.
  4. Sex with a male sex partner who has sex with men or with a partner who injects drugs

  Providers should consider discussing PrEP with other patients, even in the absence of recognized risk behaviors.

• Test for HIV during pregnancy

  1. Medical providers should test all pregnant persons when they first present for prenatal care.
  2. Persons with any of the risk factors enumerated as reasons for annual HIV testing should have repeat HIV testing during third trimester laboratory testing (typically 24- 36 weeks gestation), and again at time of delivery.
  3. Pregnant persons who have not engaged with prenatal care should be tested when they present to a clinical setting (ERs, jail, substance use treatment facilities, labor and delivery).

  The above recommendations for testing during pregnancy largely mirror recommendations for syphilis testing (441 KB) during pregnancy and medical providers should routinely order syphilis testing whenever they test pregnant persons with HIV. Medical providers should consider performing repeat HIV testing on all pregnant persons in the absence of the above risks.