Along with #metoo and many others, #believewomen is one of the social media rallying cries of the past months (and years) as women and allies have taken a stand against violence, assault and the power structures that protect perpetrators, be they an aspiring Supreme Court justice or an employee at the UN agency charged with coordinating the global AIDS response. If silence is violence, #believewomen is the response. At this week’s HIV R4P conference in Madrid, we are hearing both silence and the challenge. In this first of a series of updates from the conference, we bring you a set of session updates, and this overall observation: #believewomen has no borders. It is everywhere. Even when the discourse is polite. Here in Madrid: Skilled, esteemed speakers are saying a lot and…silence speaks volumes.

Many of the silences occur in spaces where the lives and bodies of women, girls, gay and trans people are on the line. A Monday PrEP satellite (SA16 Current State of Play: PrEP Implementation Update and Challenges) focused on experiences delivering oral PrEP in diverse countries and started with an update on implementation progress from WHO’s Michele Rodolph. She emphasized that PrEP works for men and women and that programs should be selective and permissive: targeting the strategy but also offering it to anyone who comes into a clinic asking for the strategy. She also reminded us that the primary areas of scale-up are in the US and Europe, where gay men are the predominant population accessing PrEP.

As John Brooks from the US Centers for Disease Control and Prevention noted in that session, the patterns of access do not mirror the patterns of incidence: black and brown gay men and other men who have sex with men are at the highest risk of HIV and are least likely to access PrEP. Reports from the Jilinde project in Kenya by Daniel Were and the South African National Department of Health by Hasina Subedar—some of the most well-resourced and advanced PrEP programs in sub-Saharan Africa—showed that low uptake and continuation is slowly giving way to incremental increases in use by young women and female sex workers. A presentation by Mike Cohen of the HIV Prevention Trials Network started with the statement that PrEP works in men and women, but then turned to an exploration of data on the ability to offer women a precise estimate of protection associated with daily oral PrEP, and ended with a bullet point stating that there were “concerns about PrEP as an intervention in women.” Read more via AVAC