A Qualitative Exploration of PrEP Interests, Barriers, and Interventions Among Black and Latina Cisgender Women in the U.S.

Abstract

Black and Latina cisgender women (BLCW) are disproportionally affected by HIV, particularly in the southern U.S. In Austin, Texas, Black women contract HIV 18.4 times more and Latinas 2.6 times more compared to White women. Pre-exposure prophylaxis (PrEP) is a medication that prevents contracting HIV; however, PrEP adoption among women is low. The current qualitative study aimed to explore PrEP awareness, interest, preferred PrEP administration methods, barriers to PrEP adoption, and future programs to increase PrEP adoption and adherence among BLCW. A total of 18 BLCW at high risk for HIV were enrolled. Participants completed 3 semi-structured interviews across 3 months. Interviews were transcribed verbatim, coded, and analyzed using thematic content analysis. Results demonstrated that BLCW had low PrEP awareness, high initial PrEP interest, and were interested in a long-acting injectable form of PrEP. Barriers to PrEP adoption included concerns regarding side effects, concerns about adherence to the currently available daily pill, and difficulty with insurance. Participants proposed different ideas for interventions, including support groups, education, community-level programs, and structural interventions. Future studies should focus on increasing PrEP awareness and HIV risk, consider alternative forms of PrEP, educate providers and medical staff on PrEP, and consider tailored interventions to reduce HIV risk among BLCW.

Housing Insecurity and Other Syndemic Factors Experienced by Black and Latina Cisgender Women in Austin, Texas: A Qualitative Study

“…After the informed consent was signed, the audio-recorded structured interview began to ensure additional eligibility (see Ref. [15] for in-depth procedures). All interviews were recorded using two audio recorders with microphones.…”

“…This study is an analysis of a larger qualitative study exploring barriers to pre-exposure prophylaxis (PrEP) among BLCW who were at a high risk of acquiring HIV [15]. Syndemic theory guided the development of study materials.…”

“…We interviewed participants again one month later to determine if they sought out a PrEP provider and three months later to determine if they adopted PrEP and if not, to identify syndemic barriers (see Ref. [15] for results regarding PrEP, barriers, and suggested interventions). Fourteen participants completed three interviews across three months; one participant completed two interviews and three participants completed one interview.…”

“…One participant requested that all three of her interviews were conducted in Spanish. After signing the informed consent, participants completed a structured interview regarding the remaining eligibility criteria, including participants who had at least two of the following experiences: (1) IPV in the past three months [29,30], (2) substance misuse in the past 30 days [31][32][33][34], (3) transactional sex in the past three months [31], (4) multiple sex partners in the past three months [31,35], and/or (5) their partner(s) had multiple sex partners in the past three months [15,31,35]. Exclusion criteria included (1) being less than 18-years-old, (2) identifying as any race or ethnicity aside from Black/African American or Latina/Hispanic, (3) identifying as any gender other than a cisgender woman, (4) having no children or children older than 18-years-old, (5) using condoms during every vaginal or anal sexual encounter with a cisgender man in the past 30 days, (6) living with HIV, (7) only spoke fluently in any language other than English or Spanish, and (8) having no access to a phone to determine preliminary eligibility.…”

“…Options include emergency voucher programs, a Housing Choice Voucher program (formally known as Section 8), and housing provided by local non-profits [12][13][14]. Additionally, Black and Latina cisgender women (BLCW) in Austin reported coinciding syndemic factors [15]. Therefore, it is important to explore syndemic factors within the context of housing insecurity among BLCW with children in Austin.…”