Characterizing Cis and Trans Women’s HIV Risk and Access to HIV Prophylaxis in Ontario, Canada

Despite the availability of HIV prevention medications (PrEP, PEP, and PIP), HIV rates among women continue to increase in Canada. This cross-sectional, survey-based study aimed to characterize women’s assessment of their HIV risk, along with their awareness of and access to medication-based HIV prophylaxis.

A 52-question survey was distributed at 15 community-based organizations in Ontario, Canada, including shelters, addiction treatment and recovery centres, and women’s drop-in programs, from June 2023 to February 2024. Eligible participants were self-identified women who were prophylaxis-naïve and sexually active and/or using drugs.

Of the 318 participants recruited, self-reported knowledge of HIV transmission, risk, prevention, and testing was high, with multiple strategies to decrease risk reported. Of the 302 who responded, 93.7% assessed their HIV risk as low or average; 48.7% were not aware of PrEP or PEP; 73.3% were not aware of PIP; and 89.0% and 87.8% had never been offered PrEP or PEP, respectively, although interest in both oral and injectable medications was high. Nearly half (48.4%) believed they would not qualify for PrEP, with barriers cited including perceived lack of risk (40.9%), concerns about side effects (33.6%), affordability (26.1%), and potential adherence challenges (17.0%).

Women’s self-perceived HIV risk was not congruent with objective HIV risk. Most women were unaware of HIV prevention medications and believed they would not be eligible; among those who perceived themselves as eligible, fewer than one-third had been offered HIV prevention options.

Additional clinical, public health, and policy efforts are needed to effectively engage women in HIV prevention care.