Feasibility and acceptability of pre-exposure prophylaxis use among women in violent relationships

Abstract

Intimate partner violence (IPV) is associated with a high risk of HIV acquisition. Pre-exposure prophylaxis (PrEP), which does not require partner knowledge or consent, is a promising HIV risk reduction option for women experiencing IPV. Drawing on semi-structured interviews with 26 women experiencing IPV within the last six months, this study explored the feasibility and acceptability of PrEP use in this population. Slightly more than half of the women in this study expressed interest in taking PrEP when in a relationship with an abusive partner. Potential barriers to PrEP, discussed regardless of women's expressed interest in PrEP, included fear of side effects and long-term health concerns, low risk perceptions, potential partner interference, and prioritizing coping with the relationship over HIV prevention. When offering PrEP counseling, providers should inquire about IPV, as women in violent relationships may require tailored counseling to address barriers and concerns specific to their situation.

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

“…This is illustrated by data from a study of 5606 Philadelphia residents undergoing rapid HIV testing, where the investigators categorized 71.6% of men and 60.0% of women as moderate/high risk; in contrast, only 56.8% of men and 8.3% of women perceived themselves to be high/moderate risk [ 34 ]. Populations reported to have low perceived risk include some MSM, despite their disproportionate HIV risk [ 8 ], and women at increased risk of HIV acquisition including Black women, women experiencing gender-based violence, and women involved in the criminal justice system [ 8 , 35 – 37 ]. One study also highlighted “lack of concern about HIV” as a barrier to PrEP uptake in adolescent and young adult transgender men and women [ 38 ].…”

How Has HIV Pre-Exposure Prophylaxis (PrEP) Changed Sex? A Review of Research in a New Era of Bio-behavioral HIV Prevention

“…For example, although studies report moderate to high interest in PrEP among women with IPV histories, several unique barriers to use have been identified (O'Malley et al, 2020). A few studies have reported that partner resistance to daily oral PrEP acts as a barrier to use and adherence for women who have experienced IPV, with partners assuming infidelity, undisclosed seropositivity, or lack of trust as a result of women's PrEP use (Braksmajer et al, 2019;Roberts et al, 2016;Willie et al, 2017). For example, a qualitative study of women in Uganda revealed that adherence challenges were sometimes a result of partners throwing away or threatening to dispose of women's PrEP pills (Roberts et al, 2016).…”

Intimate Partner Violence Experiences Among Men Living with HIV in Rural Appalachia

“…Among victims of IPV, data regarding individual interest and willingness to receive PrEP are variable. Some studies indicate victims of IPV are more willing to receive PrEP [16, 17], while others suggest this intervention is less acceptable in this population [18]. Concerns about stigma [19] as well as potential for partner coercion [20] have emerged as potential barriers in this population.…”