HIV Infection and HIV-Associated Behaviors Among Persons Who Inject Drugs — 20 Cities, United States, 2015

Burnett, Janet; Broz, Dita; Spiller, Michael W.; Wejnert, Cyprian; Paz–Bailey, Gabriela

doi:10.15585/mmwr.mm6701a5

Cited by 82 publications

(41 citation statements)

References 9 publications

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“…People who inject drugs (PWID) are disproportionately affected by HIV/AIDS [ 1 ], accounting for 7–10% of new HIV infections in the USA annually [ 1 , 2 ]. Needle syringe programs (NSPs) are effective in reducing HIV transmission via injection drug use and provide other essential harm reduction and health services to PWID [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, even with NSP coverage expanding, NSP access is insufficient in some areas [ 4 ], and national behavioral surveillance reveals persistent risk behavior engagement in PWID populations. For example, the 2015 National HIV Behavioral Surveillance survey in 20 US cities found that only half (52%) of HIV-uninfected PWID utilized NSPs and even fewer (34%) consistently used sterile syringes in the past year [ 2 ]. Furthermore, HIV-related risk behaviors are common in this population, with 72% reporting past year receptive syringe sharing or condomless sex [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Perspectives on HIV pre-exposure prophylaxis (PrEP) utilization and related intervention needs among people who inject drugs

et al. 2018

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BackgroundAntiretroviral pre-exposure prophylaxis (PrEP) is clinically efficacious and recommended for HIV prevention among people who inject drugs (PWID), but uptake remains low and intervention needs are understudied. To inform the development of PrEP interventions for PWID, we conducted a qualitative study in the Northeastern USA, a region where recent clusters of new HIV infections have been attributed to injection drug use.MethodsWe conducted qualitative interviews with 33 HIV-uninfected PWID (hereafter, “participants”) and 12 clinical and social service providers (professional “key informants”) in Boston, MA, and Providence, RI, in 2017. Trained interviewers used semi-structured interviews to explore PrEP acceptability and perceived barriers to use. Thematic analysis of coded data identified multilevel barriers to PrEP use among PWID and related intervention strategies.ResultsAmong PWID participants (n = 33, 55% male), interest in PrEP was high, but both participants and professional key informants (n = 12) described barriers to PrEP utilization that occurred at one or more socioecological levels. Individual-level barriers included low PrEP knowledge and limited HIV risk perception, concerns about PrEP side effects, and competing health priorities and needs due to drug use and dependence. Interpersonal-level barriers included negative experiences with healthcare providers and HIV-related stigma within social networks. Clinical barriers included poor infrastructure and capacity for PrEP delivery to PWID, and structural barriers related to homelessness, criminal justice system involvement, and lack of money or identification to get prescriptions. Participants and key informants provided some suggestions for strategies to address these multilevel barriers and better facilitate PrEP delivery to PWID.ConclusionsIn addition to some of the facilitators of PrEP use identified by participants and key informants, we drew on our key findings and behavioral change theory to propose additional intervention targets. In particular, to help address the multilevel barriers to PrEP uptake and adherence, we discuss ways that interventions could target information, self-regulation and self-efficacy, social support, and environmental change. PrEP is clinically efficacious and has been recommended for PWID; thus, development and testing of strategies to improve PrEP delivery to this high-risk and socially marginalized population are needed.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perspectives on HIV pre-exposure prophylaxis (PrEP) utilization and related intervention needs among people who inject drugs

et al. 2018

View full text Add to dashboard Cite

show abstract

“…1 Despite the efficacy of syringe service programs (SSPs) in preventing injection-related HIV transmission, 3 only about half (52%) of US PWID report having access to syringes through SSPs, and only a third (34%) consistently access sterile syringes. 4 Further, HIV-related risk behaviors are common among PWID, with 72% reporting past-year receptive syringe sharing and/or condomless vaginal or anal sex. 4 Recent HIV outbreaks (e.g., in Indiana in 2015) have revealed that, once introduced, HIV can spread rapidly within PWID networks.…”

mentioning

confidence: 99%

“…4 Further, HIV-related risk behaviors are common among PWID, with 72% reporting past-year receptive syringe sharing and/or condomless vaginal or anal sex. 4 Recent HIV outbreaks (e.g., in Indiana in 2015) have revealed that, once introduced, HIV can spread rapidly within PWID networks. 5 In the Bangkok Tenofovir Study, antiretroviral pre-exposure prophylaxis (PrEP) reduced risk of HIV infection in PWID by 48.9% overall and 83.5% among those with at least 97.5% adherence.…”

mentioning

confidence: 99%

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

Bazzi

Biancarelli

Childs

et al. 2018

AIDS Patient Care and STDs

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People who inject drugs (PWID) experience sexual and injection-related HIV risks, but uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among PWID has been low. Improving PrEP uptake in this population will require understanding of PrEP knowledge and interest. In 2017, we conducted in-depth, semistructured interviews with HIV-uninfected PWID and key informants (PrEP and harm reduction providers) in the US Northeast. Thematic analysis of coded data explored PrEP knowledge and the factors that influence PrEP interest. Among PWID (n = 33), median age was 36 years, 55% were male, 67% were white, and 24% identified as Hispanic/Latino. Accurate PrEP knowledge among PWID was low, which key informants (n = 12) attributed to PrEP marketing focused on other risk populations, as well as healthcare providers' lack of time and unwillingness to discuss PrEP with PWID. There was a discrepancy between self-reported HIV risk behaviors, which were common, and HIV risk perceptions, which varied and strongly influenced PrEP interest. Most PWID and key informants thought that PrEP would be most beneficial for those who shared syringes, used discarded syringes, engaged in transactional sex, or were homeless. Improving uptake of PrEP for HIV prevention among high-risk PWID will require education to increase PrEP knowledge and addressing factors that negatively influence PrEP interest such as perceptions regarding low HIV risk and the process for obtaining PrEP. This may require specialized PrEP marketing and outreach efforts and improved capacity of healthcare providers to effectively assess HIV risk (and perceptions) and communicate the benefits of PrEP to at-risk PWID.

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“…1 However, national surveys show that up to 70% of these high-risk individuals have not retested for HIV in the past year. [2][3][4] Developing methods to increase engagement for routine testing for them remains a top priority in the national HIV preventive strategy.…”

mentioning

confidence: 99%

“Take an HIV Test Kit Home”: A Pilot Randomized Controlled Trial Among HIV High‐risk Urban ED Patients

Kim

Patel

Gaydos

et al. 2020

Academic Emergency Medicine

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HIV Infection and HIV-Associated Behaviors Among Persons Who Inject Drugs — 20 Cities, United States, 2015

Cited by 82 publications

References 9 publications

Perspectives on HIV pre-exposure prophylaxis (PrEP) utilization and related intervention needs among people who inject drugs

Perspectives on HIV pre-exposure prophylaxis (PrEP) utilization and related intervention needs among people who inject drugs

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

“Take an HIV Test Kit Home”: A Pilot Randomized Controlled Trial Among HIV High‐risk Urban ED Patients

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