HIV screening, PrEP counseling get stronger ACOG recommendation

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, including advising of at least 1 HIV test recommendation to all people in their lifetime.^1,2

The Committee Statement updates Committee Opinion No. 595 on PrEP and Committee Opinion No. 596 on routine HIV screening, and is intended to guide obstetrician-gynecologists (ob-gyns) and other reproductive health care professionals in counseling patients on HIV risk and prevention.¹

HIV remains a substantial public health challenge in the United States, and ob-gyns are positioned to help advance the U.S. Department of Health and Human Services' Ending the HIV Epidemic initiative, which set a goal of a 90% reduction in new HIV diagnoses by 2030 through 4 pillars: early diagnosis, rapid treatment, infection prevention including PrEP, and rapid detection of and response to outbreaks.¹

According to ACOG, ob-gyns provide close to half of all women's preventive health visits annually, often the only contact some patients have with the health care system in a given year, positioning the specialty to normalize conversations around HIV risk.^1,2

The guidance calls for comprehensive, nonjudgmental sexual histories at routine wellness visits for all patients regardless of age, marital status, or perceived risk, and emphasizes a shared decision-making approach to selecting prevention strategies that fit each patient's lifestyle.^1,2

"During annual wellness visits with our patients, we are routinely discussing sex and risks for STI,” said Catherine Cansino, MD, MPH, FACOG, a named author of the guidance.²

“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 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 Cansino.

Key recommendations & data familiarity

• At least 1 lifetime HIV test recommended for all people using an opt-out approach; more frequent testing offered to those with ongoing risk factors¹
• All individuals aged 15 to 65 years should be screened at least once; pregnant patients screened at least once per pregnancy; fewer than 40% of adults had ever been tested as of 2019¹
• More than 38,000 new HIV diagnoses reported in 2024, with 7,752 (20%) among females and heterosexual contact the predominant mode of transmission in that group¹
• Black women make up 13% of the U.S. population but accounted for 50% of new HIV cases among women as of 2022; 2024 diagnosis rates were 21.6 per 100,000 among Black women, 6.4 per 100,000 among Hispanic/Latina women, and 1.8 per 100,000 among White women¹
• Individuals aged 13 to 24 years made up 18% of new diagnoses in 2024 and are the group most likely to have undiagnosed HIV¹
• The U.S. South accounted for 51% of 2024 HIV diagnoses vs 14% in the Midwest¹
• PrEP should be prescribed to adults and adolescents weighing at least 35 kg (77 lbs) with relevant risk behaviors, and to anyone who requests it¹
• A negative HIV test should be documented within the week before initiating PrEP, alongside testing for gonorrhea, chlamydia, and trichomoniasis¹
• Fewer than 10% of oral PrEP users report headache, nausea, or abdominal discomfort in the first month of use¹
• An adherence rate of 85% or greater is needed to maintain protective drug levels in vaginal tissue for oral PrEP¹
• 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 comparison¹
• Twice-yearly lenacapavir showed 100% efficacy with zero incident infections when administered as scheduled¹
• Investigational PrEP options in development include a dapivirine vaginal ring, a PrEP implant, and a combined oral PrEP/hormonal contraceptive pill¹

Screening gaps persist despite opt-out recommendation

Although opt-out testing 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.¹

"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, a named author of the guidance.²

Racial and demographic disparities shape PrEP access

Disparities in PrEP uptake remain pronounced, as historical data show White men and women were nearly 6-times more likely to be prescribed PrEP than Black men and women, and although Black individuals account for 40% of people with PrEP indications, utilization remains low, at 9.1% among males and 17.1% among females. History of intimate partner violence and transgender identity are both associated with elevated HIV risk, and affected groups face compounding barriers to PrEP access including cost, stigma, and medical distrust.¹

"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,” said Jenell S. Coleman, MD, MPH, FACOG, also a named author of the guidance.

“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 Coleman.

Limitations

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.¹

The update, according to the authors, “is intended to guide and empower obstetrician–gynecologists and other health care professionals to counsel their patients on HIV screening and prevention. Although several studies mentioned in this document pertain to ob-gyns, the recommendations on the counseling of HIV prevention and provision of PrEP apply to other reproductive health care professionals.”

References:

1. American College of Obstetricians and Gynecologists. Human immunodeficiency virus screening and preexposure prophylaxis. Committee Statement. Accessed July 2026.
2. American College of Obstetricians and Gynecologists. ACOG issues updated guidance on HIV screening and prevention, stronger recommendations for preexposure prophylaxis counseling and prescription. Press release.