ACOG Issues Updated Guidance on HIV Screening and Prevention, Stronger Recommendations for Preexposure Prophylaxis Counseling and Prescription

Washington, D.C.-The American College of Obstetricians & Gynecologists (ACOG) issued updated clinical guidance today on HIV screening and prevention, advising that at least one HIV test be recommended to all people in their lifetime using an opt-out approach, with more frequent testing offered to those with ongoing risks factors. The guidance also recommends that ob-gyns and health care professionals proactively initiate discussions about HIV prevention strategies, particularly preexposure prophylaxis (PrEP), with all sexually active adolescents and adults at increased risk of STI acquisition and prescribe PrEP to all patients at increased risk and to any patient who requests it.

The HIV epidemic continues to represent a significant public health challenge in the United States. According to CDC, more than 39,000 new diagnoses were reported in 2023, with 19% of these among females and with heterosexual contact identified as the predominant mode of transmission for that population. Disparities exist within HIV infection among U.S. women and individuals seeking ob-gyn care. Historically marginalized populations often experience barriers to PrEP uptake.

ACOG's guidance emphasizes that ob-gyns and other clinicians providing gynecologic care are uniquely well-suited to help respond to the HIV epidemic and makes recommendations to empower ob-gyns to counsel their patients about their risks and prevention options.

The guidance recommends that ob-gyns and other clinicians providing gynecologic care conduct comprehensive, inclusive, and nonjudgmental sexual histories during routine wellness visits for all individuals, regardless of age, marital status, or perceived risk.

"Combating the HIV epidemic requires that we as ob-gyns talk to our patients about their sexual histories and facilitate nonjudgmental conversations about their unique risk factors and prevention. We know from research that one of the most important factors in someone deciding to get tested is their doctor recommending the screening. We've updated screening and prevention recommendations to make it easier for clinicians to have these conversations with their patients," said Jessika A. Ralph, MD, MS, FACOG, named author of the guidance.

ACOG's updated guidance underscores the importance of the uptake of PrEP in preventing the continued transmission of HIV, alongside counseling patients on other prevention strategies, such as reducing the number of sexual partners, appropriate barrier method usage, and screening for STIs. The guidance emphasizes a shared decision-making approach in which clinicians work with patients to choose prevention strategies that align with the patients' lifestyles.

"By normalizing conversations about HIV prevention and ensuring awareness of and access to PrEP, ob-gyns can help reduce transmission and better meet the needs of the patients we care for. Ob-gyns are already accustomed to counseling patients through shared decision making using individual patient risk factors, lifestyles, preferences, and goals to guide our clinical approach. We can and should apply those same shared decision-making concepts to HIV prevention to further reduce the rates of HIV transmission in our communities," said Jenell S. Coleman, MD, MPH, FACOG, named author of the guidance.

Ob-gyns provide almost half of all women's preventive health visits annually, and those wellness visits with ob-gyns or other gynecologic care clinicians may be the only interaction some patients have with the health care system within a given year. This updated guidance encourages clinicians to use those visit opportunities to talk about HIV prevention.

"During annual wellness visits with our patients, we are routinely discussing sex and risks for STI. These conversations can be difficult for patients to bring up on their own at other medical appointments. As ob-gyns, we have a unique opportunity to counsel our patients on their risk of HIV risk and to discuss prevention strategies. By making this a routine part of our counseling, we can hopefully reduce some of the stigma of talking about HIV risk and increase uptake in PrEP for patients who can benefit," said Catherine Cansino, MD, MPH, FACOG, named author of the guidance.

ACOG Committee Statement 32: Human Immunodeficiency Virus Screening and Preexposure Prophylaxis is available now.