Brief Report: PrEP Eligibility Among At-Risk Women in the Southern United States: Associated Factors, Awareness, and Acceptability

Abstract

Background: Among women in the United States, non-Latina black women in the South have disproportionately high rates of new HIV infections but low use of pre-exposure prophylaxis (PrEP). Effective strategies to identify factors associated with PrEP eligibility could facilitate improved screening, offering, and uptake of PrEP among US women at risk of HIV. Setting and methods: We applied 2014 CDC criteria for PrEP use to at-risk HIV-negative women enrolled in the Southern US sites (Atlanta, Chapel Hill, Birmingham/Jackson, Miami) of the Women’s Interagency HIV Study from 2014 to 2015 to estimate PrEP eligibility and assess PrEP knowledge and acceptability. Factors associated with PrEP eligibility were assessed using multivariable models. Results: Among 225 women, 72 (32%) were PrEP-eligible; the most common PrEP indicator was condomless sex. The majority of PrEP-eligible women (88%) reported willingness to consider PrEP. Only 24 (11%) PrEP-eligible women had previously heard of PrEP, and only 1 reported previous use. Education level less than high school [adjusted odds ratio (aOR) 2.56; 95% confidence interval (CI): 1.22 to 5.37], history of sexual violence (aOR 4.52; 95% CI: 1.52 to 17.76), and medium to high self-perception of HIV risk (aOR 6.76; 95% CI: 3.26 to 14.05) were significantly associated with PrEP eligibility in adjusted models. Conclusions: Extremely low PrEP awareness and use despite a high proportion of eligibility and acceptability signify a critical need to enhance PrEP education and delivery for women in this region. Supplementing CDC eligibility criteria with questions about history of sexual violence and HIV risk self-assessment may enhance PrEP screening and uptake among US women.

Exploring the heterogeneity of factors that may influence implementation of PrEP in family planning clinics: a latent profile analysis

“…Clinics in the “Incompatible Setting” group may consider this referral adaption, so that women who could benefit from PrEP are at a minimum educated and made aware of the availability of PrEP services in their community. Universal education pertaining to PrEP is especially important given consistently low knowledge and awareness about PrEP reported among women in the South [ 5 , 7 ]. Other potential adaptations to PrEP, that could help overcome barriers, include pharmacy-based PrEP services (which could be useful for clinics that have a pharmacy on-site) [ 52 ], telemedicine [ 53 ], and at-home PrEP services [ 54 ].…”

“…HIV Pre-exposure prophylaxis (PrEP) is a safe and effective intervention to prevent HIV infection among women [ 3 , 4 ]. However, PrEP utilization, access, and awareness remain low among women of all ages in the US [ 5 – 9 ]. For instance, in 2017, only 6% of PrEP users were women, and among the 176,670 heterosexual women for which PrEP was indicated, only 2% received a prescription [ 10 – 13 ].…”

Achievements and gaps to provide pre-exposure prophylaxis (PrEP) for women across the European Region – Results from a European survey study

“…Provision of PrEP for women is most likely limited by multiple factors, including challenges in identifying women with an increased HIV risk. 22 Overall, there is a lack of knowledge about which sub-group of women would benefit the most from PrEP. The EACS guidelines state that “ PrEP may be considered in HIV-negative heterosexual women and men who are inconsistent in their use of condoms and have multiple sexual partners where some of whom are likely to have HIV infection and not being on treatment ”.…”

“…23 Having a history of partner violence, being recently diagnosed with a STI, and living in a high prevalence area, have also been cited in the literature as characteristics associated with PrEP eligibility among women. 22 , 24 Perceptions of HIV risk have been reported to be highly gendered and one challenge may be that many women do not consider themselves at risk of HIV acquisition 25 , 26 , particularly if they consider themselves to be in a monogamous relationship. A holistic discourse about HIV risk and risk perception that includes partner, structural and community influences may thus be particularly important for women’s uptake of PrEP.…”

“…Results from several studies suggest that women, when provided with information on the effectiveness of PrEP, are generally keen to take it. 22 , 25 , 27 , 28 However, one challenge to PrEP provision for women is that the awareness of PrEP is generally low among women. 29 In a recent study among 109 African-American women attending a family planning clinic, 80% reported that they were unaware of PrEP being available and 70% reported that they would probably or definitely like to use it.…”