Awareness of pre-exposure prophylaxis (PrEP) among women who inject drugs in NYC: the importance of networks and syringe exchange programs for HIV prevention

Abstract

BackgroundWomen who inject drugs (WWID) are at heightened risk for HIV due to biological, behavioral, and structural factors. Pre-exposure prophylaxis (PrEP) could aid in HIV prevention for WWID. However, little is known about WWID awareness of PrEP, which is a necessary step that must occur before PrEP uptake. We report factors associated with greater awareness among WWID to identify efficient means of awareness dissemination.MethodsData from the 2015 National HIV Behavioral Surveillance (NHBS) system cycle on injection drug use collected in New York City (NYC) were used. Bivariable analyses, using chi-squared statistics, were conducted to examine correlates of awareness of PrEP with socio-demographic, behavioral, and health care variables. Multivariable logistic regression was used to estimate adjusted associations and determine differences in awareness of PrEP.ResultsThe analysis consisted of 118 WWID. Awareness of PrEP was relatively low (31%), and risk factors were high. In the last 12 months, almost two thirds (65%) reported condomless sex, approximately one third (31%) reported transactional sex, and one third (32%) reported sharing injection equipment. In multivariable logistic regression, increased PrEP awareness was associated with reported transactional sex (AOR 3.32, 95% CI 1.22–9.00) and having a conversation about HIV prevention at a syringe exchange program (SEP) (AOR 7.61, 95% CI 2.65–21.84). We did not find race, education, household income, age, binge drinking, or sexual identity to be significantly associated with PrEP awareness.ConclusionsLarge proportions of WWID were unaware of PrEP. These findings suggest that social networks (specifically sex work and SEP networks) are an efficient means for disseminating messaging about prevention materials such as PrEP. We recommend that SEP access increase, SEP processes be adopted in other health care settings, and WWID networks be utilized to increase PrEP awareness.

Limited Knowledge and Mixed Interest in Pre-Exposure Prophylaxis for HIV Prevention Among People Who Inject Drugs

“…HCV, hepatitis C virus; IQR, interquartile range; PrEP, preexposure prophylaxis; SSP, syringe service program. [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]. About half (55%) identified as male.…”

“…9 A small number of surveys have identified low knowledge of the existence of PrEP among PWID in North America (ranging from 3% to 31% of samples surveyed). [10][11][12][13][14][15] Low knowledge of PrEP may result, in part, from physicians' reluctance to discuss or prescribe it to people who use and inject drugs, 16,17 possibly due, in part, to concerns or assumptions about medication adherence. 18 However, several studies have identified moderately high ''willingness'' to use PrEP among PWID, which was associated with engaging in known HIV risk behaviors.…”

“…18 However, several studies have identified moderately high ''willingness'' to use PrEP among PWID, which was associated with engaging in known HIV risk behaviors. [11][12][13][14][15] Nevertheless, in-depth research on PrEP knowledge, interest, and related intervention needs is lacking. We thus undertook a qualitative study to help inform efforts to increase PrEP uptake in this socially marginalized population.…”

PrEP awareness, eligibility, and interest among people who inject drugs in Baltimore, Maryland

“…Others found that few PWID in Vancouver were willing to use PrEP, but being at high risk for HIV was associated with increased interest in PrEP (Escudero et al, 2015). Similarly, another study in New York found that sex work and syringe exchange based social networks increased awareness of PrEP among PWID (Walters et al, 2017a). Researchers in Massachusetts found that only 7% of PWID in detoxification treatment were aware of PrEP and less than half were willing to take it (Stein et al, 2014).…”

A PrEP Information and Self-Screening Tool for Women

“…Another important factor limiting women's uptake of PrEP is that their awareness of it is low (Auerbach, Kinsky, Brown, & Charles, 2015;Collier, Colarossi, & Sanders, 2017;Walters, Reilly, Neaigus, & Braunstein, 2017). Only very recently have women-focused (e.g., Let's Talk About PrEP nationwide U.S., PrEP for Her in Washington, DC) or women-inclusive (e.g., PrEP4Love in Chicago) campaigns sought to raise awareness of PrEP among women.…”