“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

Abstract

Background Women’s rise in opioid use disorder has increased their presence in the criminal justice system and related risk behaviors for HIV infection. Although pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention treatment, uptake among this high-risk population has been particularly low. Considerably little is known about the interplay between justice-involved women with opioid use disorder and HIV prevention. The aim of this study was to explore PrEP knowledge, attitudes, and perceptions for personal and partner use among women participants in the nation’s first ever opioid intervention court program. Methods The authors conducted semi-structured, in-depth interviews with 31 women recruited from an Opioid Intervention Court, a recent fast-track treatment response to combat overdose deaths. We utilized a consensual qualitative research approach to explore attitudes, perceptions, and preferences about PrEP from women at risk for HIV transmission via sexual and drug-related behavior and used thematic analysis methods to code and interpret the data. Results PrEP interest and motivation were impacted by various factors influencing the decision to consider PrEP initiation or comfort with partner use. Three primary themes emerged: HIV risk perceptions, barriers and facilitators to personal PrEP utilization, and perspectives on PrEP use by sexual partners. Conclusions Findings suggest courts may provide a venue to offer women PrEP education and HIV risk assessments. Study findings inform public health, substance use, and criminal justice research and practice with justice-involved participants experiencing opioid use disorder on the development of gender-specific PrEP interventions with the ultimate goal of reducing HIV incidence.

Methodological issues in qualitative research on HIV prevention: an integrative review

“…When this was the case, information, knowledge, social representations, beliefs, attitudes, decision-making, perceptions, and acceptability constituted investigation objects. Other studies investigated care experiences related to preventive methods, including the use and adherence to such methods and patients’ interactions with health professionals and services 12 , 13 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 . We investigated subjects’ experiences with these preventive methods and practices at the interface with different social groups, such as heterosexual men 13 , 36 , 37 , 38 ; men who have sex with men (MSM) 25 , 30 , 39 , 40 , 41 , 42 , 43 ; women 26 , 33 , 44 , 45 , 46 ; African-Americans 21 ; women over 50 years 19 , 24 ; young people (cisgender, transgender, MSM) 16 , 27 , 34 , 35 , 40 , 47 , 48 ; and sex workers 23 , 29 , 45 .…”

“…We investigated subjects’ experiences with these preventive methods and practices at the interface with different social groups, such as heterosexual men 13 , 36 , 37 , 38 ; men who have sex with men (MSM) 25 , 30 , 39 , 40 , 41 , 42 , 43 ; women 26 , 33 , 44 , 45 , 46 ; African-Americans 21 ; women over 50 years 19 , 24 ; young people (cisgender, transgender, MSM) 16 , 27 , 34 , 35 , 40 , 47 , 48 ; and sex workers 23 , 29 , 45 . Still at the interface with preventive measures, some studies have analyzed issues related to vulnerability 15 , 22 , 49 ; explained risk behavior as the central object for analysis 14 , 31 , 35 , 39 , 42 , 47 , 50 , 51 , 52 ; masculinity 12 , 27 , 28 , 36 ; gender 22 , 50 and sexuality 16 , 43 , 53 , 54 ; and social support networks 41 .…”

“…Our third dimension of analysis investigated different methodological approaches. Among the articles we selected, some arose from research conceived as exclusively qualitative 12 , 19 , 21 , 22 , 25 , 26 , 33 , 34 , 35 , 36 , 37 , 38 , 43 , 45 , 46 , 47 , 48 , 53 , 54 ; some were based on articles with a mixed design 15 , 16 , 27 , 32 , 41 , 53 ; and some reported having a “qualitative” focus on the “phase” or “component” of broader research 13 , 20 , 24 , 28 , 29 , 30 , 31 , 39 , 40 , 44 , 47 , 52 , such as clinical trials and community-based research.…”

“…As for the explanation of the theoretical anchoring of the different methodological designs, we found studies that were based on ethnography 20 , 39 , 54 ; medical anthropology 19 ; interpretive anthropology 15 ; case study 47 ; phenomenological study 43 ; community-based study 34 ; and the Theory of Social Representations 16 . However, many studies lacked an explanation of the methodological design, citing only the methodological approach and the techniques for production and analysis 12 , 13 , 14 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 35 , 37 , 38 , 40 , 42 , 43 , 44 , 45 , 46 , 48 , 49 , 50 , 52 , 53 .…”

“…As for the production of empirical data, the most used data production techniques in the research were in-depth interviews with a semi-structured guide 12 , 13 , 14 , 15 , 21 , 24 , 25 , 26 , 27 , 29 , 31 , 32 , 33 , 36 , 37 , 40 , 43 , 44 , 46 , 48 , 51 and focus groups 30 , 34 , 35 , 50 , 53 , often combined in studies 23 , 28 , 38 , 41 , 43 , 45 , 47 , 52 or narrative interviews 12 , 19 . Anthropologically-oriented studies used field diaries as a tool for collecting information, along with other strategies, such as semi-structured interviews 19 , 22 , 39 , 54 .…”