ACOG urges routine HIV screening, broader PrEP access in ob-gyn care

Clinical takeaway: Recommend at least one lifetime HIV test using an opt-out approach, repeat testing for patients with ongoing risk factors, and offer PrEP without requiring patients to disclose stigmatized sexual or injection-related behaviors.

ACOG’s updated Committee Statement positions ob-gyns and other reproductive health clinicians as key partners in HIV prevention. The guidance recommends comprehensive, inclusive, and nonjudgmental sexual histories during routine wellness visits for every patient, regardless of age, marital status, or perceived risk. Clinicians should also consider local HIV epidemiology when discussing prevention.

All people should be offered at least one lifetime HIV screening test using an opt-out approach; patients with ongoing risk factors should be tested more often. ACOG also advises clinicians to initiate HIV-prevention discussions, including PrEP, with sexually active adolescents and adults at increased risk for sexually transmitted infections.

PrEP should be prescribed to patients at increased risk of HIV acquisition and to any patient who requests it. Available options for cisgender women include once-daily oral emtricitabine/tenofovir disoproxil fumarate, long-acting injectable cabotegravir, and twice-yearly injectable lenacapavir. Route and formulation should be selected through shared decision-making that considers preferences, lifestyle, adherence, contraindications, and drug interactions.

Before starting PrEP, clinicians should document a negative HIV test within the preceding week and test for gonorrhea, chlamydia, and trichomoniasis. HIV testing should continue at regular intervals during therapy. Patients should be reminded that PrEP does not prevent other STIs and that barrier methods remain important.

Any contraceptive method may be used with PrEP, and PrEP does not reduce contraceptive effectiveness. Oral PrEP has reassuring safety data for patients who are pregnant, lactating, or trying to conceive and remain at substantial risk of HIV acquisition.

What’s changed

• Replaces ACOG committee opinions from 2014 with a single, consolidated statement.
• Strengthens the recommendation to proactively discuss PrEP with patients at increased STI risk.
• Explicitly recommends prescribing PrEP to any patient who requests it, even without disclosed risk behaviors.
• Expands attention to long-acting options, including injectable cabotegravir and twice-yearly lenacapavir.

“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 guideline author Jenell S. Coleman, MD, MPH, FACOG.

Source: American College of Obstetricians & Gynecologists' Committee on Clinical Consensus—Gynecology. (2026 August 1). Human Immunodeficiency Virus Screening and Preexposure Prophylaxis