AIDS and Behavior

, Volume 19, Issue 5, pp 752–757 | Cite as

Acceptability of HIV Pre-exposure Prophylaxis (PrEP) Among People Who Inject Drugs (PWID) in a Canadian Setting

  • Daniel J. Escudero
  • Thomas Kerr
  • Evan Wood
  • Paul Nguyen
  • Mark N. Lurie
  • Omar Sued
  • Brandon D. L. Marshall
Brief Report


A recent clinical trial provided evidence that pre-exposure prophylaxis (PrEP) has the potential to prevent HIV infection among people who inject drugs (PWID). We examined willingness to use PrEP among HIV-negative PWID in Vancouver, Canada (n = 543) to inform PrEP implementation efforts. One third (35.4 %) expressed willingness to use PrEP, with adjusted models indicating that younger age, no regular employment, requiring help injecting, engaging in sex work, and reporting multiple recent sexual partners were positively associated with willingness to use PrEP. Although willingness to use PrEP was low, PrEP was acceptable to some PWID at heightened risk for HIV infection.


PrEP PWID Acceptability HIV Risk behavior 


Reciente se demostró que la profilaxis pre-exposición (PrEP) puede evitar la infección por VIH entre personas que se inyectan drogas por vía intravenosa (PWID). Examinamos la predisposición a utilizar PrEP entre PWID HIV negativos en Vancouver, Canadá. La tercera parte (35.4 %) estaban dispuestos a usar PrEP. En el análisis ajustado menor edad, falta de empleo estable, requerir ayuda para inyectarse, trabajado sexual y haber tenido múltiples parejas sexuales recientemente se asociaron de manera positiva a utilizar PrEP. Aunque la predisposición global a utilizar PrEP fue baja, fue aceptable para algunas PWID a mayor riesgo para la infección por el VIH.



The study was supported by the US National Institutes of Health (R01DA011591). Thomas Kerr is supported by the Michael Smith Foundation for Health Research and the Canadian Institutes of Health Research. Mark Lurie received partial support from the NIH through two research Grants (1R01MH083539-01 and 1R24HD077976-01). Daniel Escudero is supported by an NIH Grant (F31-DA037808). We would also like to thank Dr. Kenneth Mayer for his assistance with developing the survey instrument.


  1. 1.
    Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Abdool Karim Q, Abdool Karim SS, Frohlich JA, Grobler AC, Baxter C, Mansoor LE, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329(5996):1168–74.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in bangkok, thailand (the bangkok tenofovir study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2013;381(9883):2083–90.CrossRefPubMedGoogle Scholar
  5. 5.
    Alistar SS, Owens DK, Brandeau ML. Effectiveness and cost effectiveness of oral pre-exposure prophylaxis in a portfolio of prevention programs for injection drug users in mixed HIV epidemics. PLOS ONE. 2014;9(1):E86584.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Baral SD, Stromdahl S, Beyrer C. The potential uses of preexposure prophylaxis for HIV prevention among people who inject drugs. Curr Opin HIV AIDS. 2012;7(6):563–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Campbell JD, Herbst JH, Koppenhaver RT, Smith DK. Antiretroviral prophylaxis for sexual and injection drug use acquisition of HIV. Am J Prev Med. 2013;44(1 Suppl 2):S63–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Crawford ND, Vlahov D. Progress in HIV reduction and prevention among injection and noninjection drug users. J Acquir Immune Defic Syndr. 2010;55(Suppl 2):S84–7.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Dutta MJ. Disseminating HIV pre-exposure prophylaxis information in underserved communities. Am J Prev Med. 2013;44(1 Suppl 2):S133–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Escudero DJ, Lurie MN, Kerr T, Howe CJ, Marshall BD. HIV pre-exposure prophylaxis for people who inject drugs: a review of current results and an agenda for future research. J Int AIDS Soc. 2014;17:18899.CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Eisingerich AB, Wheelock A, Gomez GB, Garnett GP, Dybul MR, Piot PK. Attitudes and acceptance of oral and parenteral HIV preexposure prophylaxis among potential user groups: a multinational study. PLOS One. 2012;7(1):E28238.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Stein M, Thurmond P, Bailey G. Willingness to use HIV pre-exposure prophylaxis among opiate users. AIDS Behav. 2014.Google Scholar
  13. 13.
    Buxton J. Vancouver Site Report for the Canadian Community Epidemiology Network on Drug Use (CCENDU). 2003.Google Scholar
  14. 14.
    Kerr T, Small W, Buchner C, Zhang R, Li K, Montaner J, et al. Syringe sharing and HIV incidence among injection drug users and increased access to sterile syringes. Am J Public Health. 2010;100(8):1449–53.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Montaner JS, Lima VD, Barrios R, Yip B, Wood E, Kerr T, et al. Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study. Lancet. 2010;376(9740):532–9.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Wood E, Kerr T, Marshall BD, Li K, Zhang R, Hogg RS, et al. Longitudinal community plasma HIV-1 RNA concentrations and incidence of HIV-1 among injecting drug users: prospective cohort study. BMJ. 2009;338:b1649.CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Urban Health Research Initiative. Drug situation in Vancouver; 2009. Accessed 5 Jan 2014.
  18. 18.
    U.S. Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States—2014: a clinical practice guideline. Centers for disease control and prevention, 2014.Google Scholar
  19. 19.
    Aich TK, Dhungana M, Khanal R. Pattern of buprenorphine abuse among opioid abusers in Nepal. Indian J Psychiatry. 2010;52(3):250–3.CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    Gu J, Bai Y, Lau JT, Hao Y, Cheng Y, Zhou R, et al. Social environmental factors and condom use among female injection drug users who are sex workers in China. AIDS Behav. 2013.Google Scholar
  21. 21.
    Khan AA, Khan A. Performance and coverage of HIV interventions for injection drug users: insights from triangulation of programme, field and surveillance data from Pakistan. Int J Drug Policy. 2011;22(3):219–25.CrossRefPubMedGoogle Scholar
  22. 22.
    Hayashi K, Suwannawong P, Ti L, Kaplan K, Wood E, Kerr T. High rates of midazolam injection and associated harms in Bangkok, Thailand. Addiction. 2013;108(5):944–52.CrossRefPubMedGoogle Scholar
  23. 23.
    Kerr T, Marshall BD, Milloy MJ, Zhang R, Guillemi S, Montaner JS, et al. Patterns of heroin and cocaine injection and plasma HIV-1 RNA suppression among a long-term cohort of injection drug users. Drug Alcohol Depend. 2012;124(1–2):108–12.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Fairbairn N, Small W, Van Borek N, Wood E, Kerr T. Social structural factors that shape assisted injecting practices among injection drug users in Vancouver, Canada: a qualitative study. Harm Reduct J. 2010;7:20.CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Richardson LA, Milloy MJ, Kerr TH, Parashar S, Montaner JS, Wood E. Employment predicts decreased mortality among HIV-seropositive illicit drug users in a setting of universal HIV care. J Epidemiol Community Health. 2014;68(1):93–6.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Goldenberg SM, Chettiar J, Simo A, Silverman JG, Strathdee SA, Montaner JS, et al. Early sex work initiation independently elevates odds of HIV infection and police arrest among adult sex workers in a Canadian setting. J Acquir Immune Defic Syndr. 2014;65(1):122–8.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Arnold EA, Hazelton P, Lane T, Christopoulos KA, Galindo GR, Steward WT, et al. A qualitative study of provider thoughts on implementing pre-exposure prophylaxis (prep) in clinical settings to prevent HIV infection. PLOS One. 2012;7(7):E40603.CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    Galai N, Safaeian M, Vlahov D, Bolotin A, Celentano DD, Study A. Longitudinal patterns of drug injection behavior in the ALIVE Study cohort 1988–2000: description and determinants. Am J Epidemiol. 2003;158(7):695–704.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Daniel J. Escudero
    • 1
  • Thomas Kerr
    • 2
    • 3
  • Evan Wood
    • 2
    • 3
  • Paul Nguyen
    • 2
  • Mark N. Lurie
    • 1
  • Omar Sued
    • 4
  • Brandon D. L. Marshall
    • 1
  1. 1.Department of Epidemiology, School of Public HealthBrown UniversityProvidenceUSA
  2. 2.British Columbia Centre for Excellence in HIV/AIDSSt. Paul’s HospitalVancouverCanada
  3. 3.Department of MedicineUniversity of British ColumbiaVancouverCanada
  4. 4.Fundación HuéspedBuenos AiresArgentina

Personalised recommendations