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Integrating PrEP to End HIV
Women’s Health Is Community Health: Integrating PrEP Into Community-Based Services to End HIV

Released: February 17, 2026

Nelly Rwamba Mugo
Nelly Rwamba Mugo, MBChB, MMed, MPH
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Key Takeaways
  • Integrating HIV prevention with community services delivers benefits far beyond the individual.
  • Successful PrEP integration requires early HCP training, community engagement, and sustained investment so people are empowered with real choices for HIV prevention.

Let me begin with a story from many years ago, before our clinic standardized HIV screening and prevention in antenatal services. A woman came to my clinic and told me she had tested positive for HIV. She said, “I had my last delivery here 2 years ago, and nobody spoke to me about HIV. Nobody told me that I was at risk. I am married. I thought I was safe. Nobody talked to me.” We failed her. The system failed her. If we want to avoid more cases like hers, we must integrate pre-exposure prophylaxis (PrEP) into traditional women’s healthcare.

HIV Is a Women’s Epidemic
PrEP integration into community-based services, like family planning and maternal child health services, seems like a natural step forward for HIV prevention in sub-Saharan Africa, because the epidemic here is primarily a women's epidemic. The highest incidence of HIV in this region is among young women between ages 15 and 24. Although some of this is due to the female anatomy, significant social factors also play a role.

A major risk for HIV transmission is community viral load, or how prevalent HIV is in one’s community. Even if an individual has only 1 partner, if the background HIV prevalence is 20%, there is a 1 in 5 chance that their partner will have HIV.

Integrating PrEP Into Women’s Healthcare
Despite the prevalence of HIV in these regions, I have found that many young women are a lot more afraid of pregnancy than HIV. So, if healthcare professionals (HCPs) want to meet vulnerable young woman at their point of need, integration of HIV care with family planning and sexual healthcare should be our first priority.

I think one of the strongest data points for PrEP integration was the ECHO trial, which evaluated whether certain contraceptives were associated with increased susceptibility to HIV acquisition.

There were no differences in HIV incidence between any of the methods of contraception tested, but investigators reported extremely high rates of HIV incidence among the young women who participated. Imagine if these women using contraception were also on PrEP. How many HIV infections could that prevent?

Preventing HIV early can have a lasting impact. When a woman without HIV starts a family, her husband is also more likely to remain free of HIV, and so are her children, lowering their risk for HIV-associated secondary diseases, such as Kaposi's sarcoma and cervical cancer. So PrEP integration into community-based services can truly have a community benefit.

Taking Practical Steps Towards PrEP Integration
A key step is incorporating education on HIV prevention and treatment into reproductive health training. If HIV prevention is integrated early on during training of HCPs, it becomes a natural thing to offer.

HIV-associated stigma is still prevalent in my region. So, my colleagues and I sought to introduce HIV screening and PrEP into postabortion care services because abortion is stigmatized already, too. Women with prior abortions are more likely to have a repeat abortion, demonstrating continued risk and unprotected sex.

In a study evaluating introduction of PrEP to postabortion care services, the biggest barrier to PrEP delivery was low knowledge of HIV prevention and the discomfort in HIV testing among the reproductive health care professionals. In clinics, where the team leads advocated for integration of HIV prevention services including PrEP, uptake was high with easier adaptation of the integrated process.

My advice for successful integration of HIV care and prevention is 3-fold. First, you must work with your HCPs. You must understand their biases and help them overcome the stigma surrounding HIV.

Second, you must understand your community. You must talk to key opinion leaders early on. Religious leaders and their platforms can contribute to the stigmatization of women’s sexuality. If we do not engage those platforms, they will be a barrier to uptake. We may come up with brilliant, safe, low-cost interventions, but if the community is not open to using them, population impact will not be achieved.

Third, you must determine the investment required to reach the population carrying the burden of HIV infection. Often, our partners come with product but no means to support its implementation. We need to support advocacy in the community and engagement with key stakeholders, as well as early education for reproductive health workers.

Choice Is Empowerment
Ultimately, when we do not give women the choice to engage in HIV prevention, we are failing them. 

I began with the story of a woman we failed. This story sticks out to me. She came to us for her pregnancy but we did not address her future risk of getting HIV. Let’s not miss these opportunities.

Your Thoughts
What steps can you take to integrate HIV care and prevention into your own practice? Leave a comment to join the discussion!

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