Pre-exposure prophylaxis (PrEP) is a promising intervention to prevent HIV acquisition,
with benefits both to the individual and to population-level health. PrEP is an opportunity
to complement ongoing public health efforts to eliminate HIV. For women, PrEP can
also serve as a gateway to access sexual and reproductive health (SRH) services. Clinical
efficacy of PrEP was initially reported in women using a 1% tenofovir vaginal gel
in 2010, followed by an efficacy trial of oral PrEP using TDF/FTC in men who have
sex with men (MSM). Since then, further trials have reported efficacy in oral PrEP
containing tenofovir in women and heterosexual men, while the subsequent trials for
women using tenofovir gel reported no efficacy, stemming from difficulties in achieving
adequate adherence. In an effort to offer women additional choices to oral PrEP, alternative
modalities are being tested in clinical research, including long-acting injectable
formulations and intra-vaginal rings. In 2015, a meta-analysis of clinic trials and
open-label extension studies led to the World Health Organization (WHO) strongly recommending
the provision of oral PrEP containing tenofovir for any person at substantial risk
of HIV infection, irrespective of gender or population group. Currently, PrEP services
for women around the world, including those who are either pregnant or breastfeeding,
remain limited. Outside sub-Saharan Africa, most PrEP programmes are focused on MSM.
South Africa, Kenya, and the USA have the greatest utilization of oral PrEP by women.
Yet, since 2012, of the estimated > 300,000 people globally who have initiated PrEP,
a minority are women. In this narrative review, we examine the most recent literature
on clinical and implementation PrEP research among women. We highlight the high burden
of disease related to common sexually transmitted infections (STIs) in women, and
the opportunity to integrate PrEP and other HIV prevention services, STI case management,
and family planning services, as part of a more robust package of SRH services. Raising
awareness on PrEP amongst women and their healthcare providers, minimizing gaps in
access, and ensuring adherence and persistence of PrEP during periods of risk are
critical issues if PrEP can have a meaningful impact on reducing HIV incidence in
women globally.