Awareness and acceptability of HIV pre-exposure prophylaxis (PrEP) among students at two historically Black universities (HBCU): a cross-sectional survey

Abstract

Background Despite young African American adults (ages 18–24) being among the highest risk groups for HIV infection, little is known about their awareness of HIV pre-exposure prophylaxis (PrEP) – a once daily pill shown to be > 90% effective in preventing HIV. To explore awareness and acceptability of PrEP among college students in this demographic, we conducted a survey of attendees at two large historically Black universities (HBCU) in North Carolina. Methods We administered a 14-item questionnaire to students at two HBCUs in North Carolina between February and April 2018. Questions were formatted in a yes/no or multiple choice format. Questionnaire items specifically addressed PrEP awareness and acceptability. Surveys were administered to students at a campus health fair and while transiting the campus student union via iPad. Response to all questions was optional. We fit a logistic regression model to determine association of key demographic determinants with PrEP acceptability and awareness. Statistical analyses were conducted using SAS 9.4 (SAS, Cary, NC). Results Overall, 210 students participated in the survey, of which 60 completed all survey items as presented. The survey cohort was 75% female, 89% heterosexual and 39% freshmen. The mean age of respondents was 19.8 years (SD: 1.8). Fifty-two percent of survey respondents reported that they were aware of PrEP prior to the time of survey administration. Only 3% of respondents reported that they were on PrEP. The most common sources of information on PrEP were campus health services (24%) and non-social media advertising (15%). Of respondents who were aware of PrEP, 61% reported that they had heard about in the 6 months prior to survey administration, while only 19% say they were aware of it for more than a year. Regarding acceptability of PrEP, 58% of respondents reported that they would take a once a day pill for HIV if they were at risk. Our logistic regression analysis found no statistically significant associations between key demographic factors and PrEP awareness. However, persons who perceived themselves to be at risk for HIV acquisition were more likely to find once daily oral PrEP (relative risk 2.66 (95% CI 1.31–5.42)) as an acceptable prevention strategy than the rest of the survey cohort. Conclusions African American HBCU students are becoming aware of PrEP, and generally perceive the intervention as acceptable and worth consideration.

“We Feel Like Everybody's Going to Judge us”: Black Adolescent Girls’ and Young Women's Perspectives on Barriers to and Opportunities for Improving Sexual Health Care, Including PrEP, in the Southern U.S

“…Within a population of young adults attending Historically Black Colleges and Universities, 52% indicated prior knowledge of PrEP, however, only 3% reported current PrEP usage. 45 Among our sample of AGYW, many did not perceive themselves as at risk for HIV because they were in monogamous relationships. While having fewer partners may decrease their risk of HIV acquisition, relationships among this age group may be more transient than AGYW perceive, and heterosexual women's HIV vulnerability is more closely linked to their sexual networks than their individual behaviors.…”

Knowledge, Attitudes, and Utilization of HIV PrEP among Black College Students in the United States: A Systematic Review

“…Knowledge regarding the existence of HIV PrEP is on average 27% (i.e., 10%, 14%, 33%, 52%) across the four studies included in this review (see summary Table 2), indicating that majority of Black college students are unaware of this crucial prevention resource [18,19,21,22]. Irrespective of knowledge or lack thereof of HIV PrEP, there is a generally low selfperceived HIV risk even in participants who are unaware of their HIV status, contributing to the generally low interest and utilization of HIV PrEP, particularly in the absence of educational intervention [18].…”

“…In fact, the majority of students believed they had a HIV negative status, in the absence of ever testing for HIV [18,22]. Findings suggest that many students, who had no previous knowledge regarding HIV PrEP and had never been tested for HIV, were sexually active with multiple partners [18,21]. Overall, knowledge of HIV PrEP appears to be negatively associated with stereotypes (such as promiscuity, sex work, injection drug use), raising issues about the role of educational interventions on PrEP initiation and HIV prevention among this un-engaged atrisk population [19].…”

“…Despite recent progress in HIV prevention, Blacks/African Americans (referred to as Black hereafter) account for more than 40% of new HIV infections [1], a reality compounded by empirical evidence associating young Black adults with the highest risk for new HIV infection [2]. Nevertheless, some young Black students have touted a low HIV risk regardless of their HIV status or the current state of the domestic HIV epidemic [3].…”

“…In the general Black population, factors contributing to high infection rate (i.e., low risk self-perception for HIV, fear of HIV PrEP side effects, and cultural resistance to HIV-PrEP) may also be responsible for low knowledge, misdirected and unfavourable attitudes, and low utilization of PrEP among Black college students [15,16]. Surprisingly, few studies have explored Black college students in the context of HIV PrEP; clearly, research addressing sexuality and HIV PrEP amongst Black college students are limited [17][18][19][20].…”