HIV Risk perception and eligibility for pre-exposure prophylaxis in women involved in the criminal justice system

Abstract

Women involved in the criminal justice system (WICJ) are at high risk of acquiring HIV and would benefit from HIV pre-exposure prophylaxis (PrEP) but there are no studies in this population to inform PrEP implementation programs. We conducted a cross-sectional survey of HIV-uninfected, cis-gender women on probation, parole and/or recently released from prison/jail to assess PrEP awareness, eligibility, potential barriers to uptake, and the PrEP care continuum. The 125 WICJ surveyed reported high rates of HIV risk behaviors including recent transactional sex (22.4%) and unsafe injection practices (14.4%). Despite 33% (n = 42) meeting eligibility criteria for PrEP, only 25% were aware of PrEP and one person was currently using it. Just 16.7% of those who were PrEP eligible perceived they were at risk for HIV. Following a brief explanation of PrEP, 90% said they would try it if recommended by their physician. Compared to those not PrEP eligible (n = 83), PrEP eligible women were less likely to be stably housed or have a primary care provider, and were more likely to be violence-exposed, charged with drug possession, have lifetime substance use, or living with Hepatitis C infection. WICJ frequently engage in HIV risk behaviors that make them eligible for PrEP. Uptake may be limited by lack of PrEP awareness or underestimation of personal HIV risk. WICJ report receptiveness to PrEP and represent an important population for targeted PrEP implementation programs.

Barriers to linking high-risk jail detainees to HIV pre-exposure prophylaxis

“…Additionally, individuals within incarcerated settings may not perceive themselves to be at significant risk for HIV infection. In a recent survey study of incarcerated women who engaged in high-risk behaviors and who were eligible for PrEP, only 17% perceived themselves to be at risk for contracting HIV [23]. This mirrors our findings in that numerous participants in our study articulated a low perception of risk because they did not see themselves fitting into a specific risk group, such as IDU or MSM.…”

“I think everybody should take it if they’re doing drugs, doing heroin, or having sex for money”: a qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program

“…In this sample of cisgender women with OUD recruited from a specialized opioid court program, PrEP awareness was present, yet knowledge was limited; this finding is consistent with prior work among women [ 34 , 35 ]. In addition, participants reported rates of bacterial STIs and hepatitis C higher than the general population [ 36 ] indicating increased HIV risk.…”

“I think everybody should take it if they’re doing drugs, doing heroin, or having sex for money”: A qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program

“…In this sample of women with OUD recruited from a specialized opioid court program, PrEP awareness was present, yet knowledge was limited; this nding is consistent with prior work among women (28,29). In addition, participants reported rates of bacterial STIs and hepatitis C higher than the general population (30) indicating increased HIV risk.…”

“…Such miscalculated HIV risk perceptions may contribute to missed opportunities for PrEP engagement. This disconnect is a growing problem, as those individuals eligible for PrEP may be least likely to seek preventive screening (29). In addition, PrEP interest and motivation were impacted by various factors in uencing the decision to consider PrEP initiation or comfort with partner use.…”