HIV Pre-Exposure Prophylaxis Prevention Awareness, Willingness, and Perceived Barriers among People Who Inject Drugs in Los Angeles and San Francisco, CA, 2016–2018

Abstract

Background: Pre-exposure prophylaxis (PrEP) for HIV prevention is indicated for people who inject drugs (PWID), yet most studies exclude PWID. This study examines factors associated with PrEP awareness and willingness, and identifies perceived barriers to PrEP among PWID.Methods: PWID were interviewed in Los Angeles and San Francisco, CA from 2016 to 2018. We analyzed data from self-reported HIV-negative participants who had injected drugs within the past 6 months (n=469). Questions on PrEP included awareness, willingness, barriers, and uptake. Multiple logistic regression models of factors associated with awareness of, and willingness to, take PrEP were developed. Descriptive statistics on perceived PrEP barriers are reported.Results: Among HIV-negative PWID, 40% were aware of PrEP, 59% reported willingness to take PrEP, and 2% were currently taking PrEP. In multivariable analysis, PrEP awareness was associated with study site and sexual minority status, higher educational attainment, and HIV testing in the last 6 months. Willingness to take PrEP was associated with self-reported risk (paying sex partner in the last 6 months, sharing drug paraphernalia, and being injected by another PWID) and perceived HIV risk. The most common perceived barriers to PrEP were copays, concerns about increase in HIV or sexually transmitted risk with PrEP, and concerns about reduction of medication efficacy without daily use. Conclusion:PrEP awareness among PWID remains inadequate. Willingness to take PrEP was moderate and was most desired by PWID who engaged in high-risk behaviors. Interventions to increase PrEP awareness and willingness, and to facilitate PrEP uptake among PWID are needed.

Considerations for the Design of Pre-exposure Prophylaxis (PrEP) Interventions for Women: Lessons Learned from the Implementation of a Novel PrEP Intervention

“…As a user-controlled HIV prevention method, PrEP may be particularly important for women who engage in exchange sex and/or use drugs, especially those who inject drugs who may be at risk for HIV and struggle in negotiating condoms or drug use equipment [ 25 , 26 ]. However, despite PrEP’s potential benefit, PrEP uptake in the U.S. have been persistently low among women [ 27 – 31 ].…”

“…Importantly, women who perceive their risk as low have reported behaviors, such as condomless sex and sharing injection equipment, indicating they may be at greater risk than perceived [ 34 , 36 ], thus highlighting the importance of HIV prevention education including information about PrEP. Concerns about side effects and cost of PrEP [ 35 , 37 – 39 ], reduced efficacy if not taken daily [ 31 ], PrEP-related stigma [ 39 – 41 ], and medical mistrust [ 37 ], including mistrust due to transphobia experienced by women of trans experience [ 42 ], have also been identified in previous studies. Along with barriers some studies have identified facilitators to PrEP uptake, such as learning about PrEP from a trusted source [ 43 ] and having a welcoming, client-centered, culturally appropriate environment that is stigma free allowing for positive interactions with PrEP prescribers [ 35 , 43 , 44 ].…”

PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure

“…Studies among sexual minority men and transgender women, which focus on sexual transmission, have found about 99% efficacy when taken regularly [ 3 , 4 ]. Despite the benefit of PrEP, uptake among PWID has been low, with recent studies reporting between 1 and 2% [ 5 , 6 ]. One barrier to PrEP uptake is low PrEP awareness [ 5 , 7 , 8 ].…”

“…Yet, when informed about PrEP, many PWID are interested in taking it. For example, one study reported 63% willingness to take PrEP among PWID in Baltimore, Maryland [ 5 ], and another study found 59% among PWID in San Francisco and Los Angeles, California [ 6 ]. In addition to awareness, barriers to uptake include co-pays for doctors’ visits, the need to take PrEP daily, and concerns about increased risk for HIV or sexually transmitted infections with PrEP [ 6 ].…”

“…For example, one study reported 63% willingness to take PrEP among PWID in Baltimore, Maryland [ 5 ], and another study found 59% among PWID in San Francisco and Los Angeles, California [ 6 ]. In addition to awareness, barriers to uptake include co-pays for doctors’ visits, the need to take PrEP daily, and concerns about increased risk for HIV or sexually transmitted infections with PrEP [ 6 ]. In addition, PrEP prescribers are less willing to prescribe PrEP to PWID, compared to sexual minority men who do not inject drugs [ 9 , 10 ].…”