The American College of Obstetricians and Gynecologists (ACOG) has issued updated guidance on HIV screening and prevention, calling for more consistent clinician engagement in preexposure prophylaxis (PrEP) counseling and prescribing. The statement updates previous Committee Opinions and is intended to guide obstetrician-gynecologists and other reproductive health care professionals in counseling patients on HIV risk.
Screening Gaps Persist Despite Updated Recommendations
Although an opt-out testing approach is now recommended for all patients at least once in their lifetime, uptake lags. As of 2019, fewer than 40% of adults had ever been tested, and among people with HIV risk factors, only a quarter reported being offered testing during a health care visit in the prior year. Patients most often cite a clinician’s recommendation as the deciding factor in getting tested.
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Disparities in Uptake
Black women make up 13% of the U.S. population but accounted for 50% of new HIV cases among women as of 2022. The U.S. South accounted for 51% of 2024 HIV diagnoses compared to 14% in the Midwest.
Key Data on HIV in the U.S.
Key recommendations from the guidance include: at least 1 lifetime HIV test for all people using an opt-out approach, and more frequent testing for those with ongoing risk factors. All individuals aged 15 to 65 years should be screened at least once, and pregnant patients screened at least once per pregnancy.
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More than 38,000 new HIV diagnoses were reported in 2024, with 7,752 (20%) among females. Black women make up 13% of the U.S. population but accounted for 50% of new HIV cases among women as of 2022. The U.S. South accounted for 51% of 2024 HIV diagnoses compared to 14% in the Midwest.
PrEP and Prevention Options
PrEP should be prescribed to adults and adolescents weighing at least 35 kg (77 lbs) with relevant risk behaviors, and to anyone who requests it. A negative HIV test should be documented within the week before initiating PrEP, alongside testing for gonorrhea, chlamydia, and trichomoniasis.
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Long-acting injectable cabotegravir demonstrated 93% on-time injection coverage and an 88% reduction in HIV incidence among cisgender women, outperforming oral tenofovir disoproxil fumarate-emtricitabine in the same comparison. Twice-yearly lenacapavir showed 100% efficacy with zero incident infections when administered as scheduled. Fewer than 10% of oral PrEP users report headache, nausea, or abdominal discomfort in the first month of use.
An adherence rate of 85% or greater is needed to maintain protective drug levels in vaginal tissue for oral PrEP. Investigational PrEP options in development include a dapivirine vaginal ring, a PrEP implant, and a combined oral PrEP/hormonal contraceptive pill. The Committee Statement noted that clinical efficacy data on HIV screening tests, treatments, and PrEP itself were considered out of scope; clinicians are directed to CDC and U.S. Preventive Services Task Force guidance for those clinical specifics.
