Gender-related Barriers to Emerging HIV Prevention Methods: A Review of Post-exposure Prophylaxis (PEP) Guidelines Britt Herstad, Health Policy Initiative, Task Order 1/Constella Futures XVII International AIDS Conference Mexico City August 6, 2008

Presentation outline Background Analysis framework Review findings of guidelines Looking forward

Background: Gender in PEP and sexual assault guidelines Currently PEP is a vital intervention for sexual assault survivors Growing interest in expanding PEP as prevention method Yet... Limited understanding of how PEP sexual assault guidelines are implemented No explicit framework for gender analysis of these guidelines Even though experience from HIV and gender-based violence (GBV) reveals addressing gender barriers is key to program success

PEP Guidelines Reviewed: PEPFAR focus countries

Framework – Gender analysis of PEP guidelines for sexual assault Do guidelines provide PEP for sexual assault? Is an HIV test required? What are the legal requirements? What are the facilities? What are the costs? Gender- equitable provision of PEP Criteria for access Elements of service provision What are adherence issues? Potential gender barriers to address Who are providers?

Review findings

Beginning with the basics: PEP provision and eligibility 13 countries include in guidelines (n=14) Most pay minimal attention (e.g., Cote d’Ivoire) A few offer detailed guidance (e.g., Kenya) 9 countries use gender neutral terms 4 countries refer to “men and women” and “girls and boys” 0 countries refer to specific vulnerable groups PEP provision for sexual assault Who is eligible?

Is HIV testing and counseling required? VCT gender barriers Policy findings Informed consent, counseling Disclosure can result in blame, stigma and discrimination, abandonment, and additional violence All countries require HIV test for PEP provision 5 countries allow PEP to begin before HIV test is taken or results are known “It may be difficult to obtain informed consent for HIV testing shortly after the rape.” –Namibia’s Guidelines

How much does PEP cost for sexual assault? Gender related to cost barriers Policy findings Women often have less financial decisionmaking power Women often have fewer economic resources Most guidelines do not specify costs 1 country provides information on fees –Guyana: free

What are adherence issues? Gender adherence barriers Policy findings Lack of transportation for PEP dosage, follow-up testing Lack of safe water, food, economic resources Disclosure and stigma 2 countries address adherence barriers –Kenya, South Africa allow extra doses 0 countries refer to stigma or disclosure

Looking Forward

Implications Currently, majority of guidelines provide for PEP for sexual assault, but are gender blind and lack detail In the future, guidelines can explicitly address potential gender barriers to achieve equitable provision of PEP Gender- sensitive PEP sexual assault guidelines Facility access Cost Community outreach Range of beneficiaries VCTProviders Adherence