This International Women’s Day, it’s important we reflect the areas where women are still being left behind in relation to HIV and sexual health – and what actions the Government needs to take to change this.
This year’s International Women’s Day is themed around embracing equity. A year ago we wrote about women being treated as an afterthought in HIV and sexual health policy. So has this situation changed? Sadly, the position remains much the same, if not worse.
Women are continuing to be left behind when it comes to HIV diagnosis. While the figures have narrowed in the last two years, women are still much more likely than men to be diagnosed with HIV late. Testing rates for HIV in sexual health services collapsed during the pandemic for all groups, but have now largely recovered for gay and bisexual men. However, the number of women tested for HIV in 2021 was 22% lower in 2021 than it was in the year leading up to the start of the pandemic – and 43% of women weren’t offered an HIV test when they attended a sexual health service.
One area where progress is being made in testing for HIV is via opt-out testing in accident and emergency (A&E) departments. This is where testing for HIV is done as standard when someone has a blood test in some emergency departments in England, allowing A&E to make every contact count when it comes to finding people living with undiagnosed HIV.
Women make up 25% of new HIV diagnoses each year, and yet the first trials of opt-out testing found that women account for 40% of people being diagnosed in A&E. Even more strikingly, 54% of people diagnosed with HIV were Black African, Black Caribbean or Black ‘other’, more than twice as many as the nationwide average of 22%. This means opt-out testing has done more than any other intervention to address health inequalities.
At the moment though, opt-out testing is only available in areas of ‘very high’ HIV prevalence in England. We want to see this expanded to areas of ‘high’ prevalence, which would see opt out testing introduced in a more than 40 other hospitals – and for other parts of the UK to follow suit.
It’s also vital that women at risk of exposure to HIV are able to access tools to prevent getting HIV in the first place, and PrEP is vital to this. However, the Not PrEPared report, which we published jointly with National AIDS Trust, PrEPster, One Voice Network and Sophia Forum last autumn, found that the majority of women in need of PrEP aren’t being offered it. Not a single local authority in England reported more than five women using PrEP in any of their services.
The UK Health Security Agency (UKHSA) estimates that just under a third of the 3,000 heterosexual and bisexual women using sexual health services in England with a need for PrEP are accessing it. This suggests there is a clear need for commissioners and service providers to engage with women specifically and reduce the barriers to accessing PrEP. One way that this can change is to pilot making PrEP available in settings other than sexual health services that women are more likely to use, for example community pharmacies.
Finally, women need to be able to access sexual and reproductive health services. It’s been almost four years since the Government committed to a strategic review of sexual and reproductive health, and yet nothing is forthcoming. In the meantime, women are experiencing increasing health inequality as a result of services that the Local Government Association very recently described as being at 'breaking point'.
Initial findings from a major research project we're undertaking looking at unmet need in sexual health has already uncovered worrying results, with women reporting issues getting appointments, delays accessing long-acting and emergency contraception, and struggling to get the information they need. Women urgently need this review to happen.
In the year ahead, these are the three key things the Government can do to improve equity for women in HIV and sexual health:
- Expand A&E opt out testing to areas of ‘high’ HIV prevalence, so that more women living with undiagnosed HIV can be found earlier.
- Pilot providing PrEP via settings outside of sexual health services, for example in community pharmacies, in order to increase uptake amongst women.
- Produce the long-overdue Sexual and Reproductive Health Action Plan – and make sure it prioritises addressing the inequalities faced by women.
Ceri Smith is our Head of Policy.
