Just a small question about PrEP…

As questions concerning PrEP abound, Juno Roche looks at the issue of the omission of women in the discourse around HIV.


This is just a question. Alright, I get it’s a loaded question but it’s coming from an honest place and I take responsibility for asking it.

Why are women constantly absent from most conversations, rallying cries and campaigns around HIV?

Frequently, lists of risk-hierarchy are written, published, printed which include; MSM, gay men, sex workers and trans women, but women (half the world) are left out. Worldwide, over 50% of all new HIV infections are women.

I shouldn’t complain; as a trans woman who has life experience of drug addiction and sex work, I’m often included somewhere near the top of the list. Recently, someone told me I was a whore for having HIV and still expecting to meet someone via a dating site. I quickly told them that I’m not a whore anymore – now, I’m all apple pie and cream and ready for love. But obviously, people still see me as a high-risk; obviously, the link between HIV and ‘other’ is still incredibly powerful in people’s minds.

I think that, ironically, if you exclude one group (let’s say a woman whose husband plays away occasionally – MSM), you create risk rather than addressing existing risks. When you decide funding needs, medical trials and data collection based on crude risk factors, you are working with approximates of perception and with estimates of  numbers.

I imagine that we could and should effectively target communities against whom local societies discriminate, such as trans sex workers in parts of India (80%+ infection rates), rather than blanketing all trans people or all sex workers or all trans sex workers. Is the risk to a white sex worker in London the same as a sex worker in Bangladesh or Mexico City?

Worldwide, over 50% of all new HIV infections are women.

Are all MSM at risk or for that matter, are they all gay men? And conversely, are all women not at risk?

I recognise that as women we can be included as sex workers but this is hugely derivative in terms of our representation. Our sole representation in a grouping considered to be high-risk.

What message does the omission of women send to younger girls and women? That they are not at risk from HIV, that they need not worry? Are we not treating women in a way that echoes Victorian ideas about women and sex? We really are in danger of continuing to dig the same trenches and issuing the same edicts to society at large about HIV. The idea that HIV targets high-risk people and that women are not generally high risk is just not true. Women move in and around society – they do not exist in a safe bubble.

Society constantly pigeon-holes people it sees as ‘problematic’ into high-risk ghettos of thought. Yet, we know that a young woman on her first sexual date is as exposed to risk (without protection) as anyone else in any other group.

PrEP absolutely has a place and an incredibly effective purpose but our fight for it should be made justly and honourably and should be based on its brilliance at stopping the infection. Wouldn’t it be better if women who felt they were at risk by their personal circumstances (not something ever reflected in data but the essence of infection) could approach a healthcare worker and express their desire to be able to responsibly protect themselves?

We are living in a time when young women experience a wide range of gender-based violence and forced sex (look at the recent data around rape in our schools), yet we exclude this risk.

People, all of us should recognise that this denial of female risk is structural and implicit sexism and we should be bold enough to contest and address this. We are constantly told that in all sectors of society, young girls are bombarded with sexualised imagery and hyper-sexualised expectations and they are raised within societies that we know by great rafts of evidence are built upon inequality. Far too often, we are still judged by our appearance  and our sex appeal, our bodies judged by many to be unsexy, sexy, too sexy or overtly sexual. We still have to fight worldwide for bodily agency on a multitude of issues, from FGM to abortion. Society places women constantly in risk-streams.

We are living in a time when young women experience a wide range of gender-based violence and forced sex (look at the recent data around rape in our schools), yet we exclude this risk.

Women are aggressively (I accept sometimes unwittingly) placed outside of the HIV debates. Furthermore, ‘men who sleep with women’ (perhaps some of the sex workers) are also not deemed to be ‘high-risk’ and placed outside of the debates.

These are rather convenient and simplistic views about people and risk that uphold binary and inflexible notions of gender, sexuality and risk within society. They are not helpful in addressing the risk of HIV in its widest sense and not helpful in boldly seeking to implement a PrEP strategy that could make a real difference in the fight against HIV.

Juno Roche is a Trustee of the Sophia Forum. You can follow her on Twitter (@JustJuno1).

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