Biomedical HIV prevention uptake has not taken hold among Black and Latinx populations who use street-marketed drugs. A pilot intervention providing a PEP informational video and direct pharmacy access to a PEP starter dose was conducted among this population. Four study pharmacies were selected to help facilitate syringe customer recruitment (2012–2016). Baseline, post-video, and 3-month ACASI captured demographic, risk behavior, and psychosocial factors associated with PEP willingness, and willingness to access PEP in a pharmacy. A non-experimental study design revealed baseline PEP willingness to be associated with PEP awareness, health insurance, being female, and having a high-risk partner (n = 454). Three-month PEP willingness was associated with lower HIV stigma (APR = 0.95). Using a pre-post approach, PEP knowledge (p < 0.001) and willingness (p < 0.001) increased overtime; however, only three participants requested PEP during the study. In-depth interviews (n = 15) identified lack of a deeper understanding of PEP, and contextualized perceptions of HIV risk as PEP access barriers. Pharmacy PEP access shows promise but further research on perceived risk and HIV stigma is warranted.
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Otten RA, Smith DK, Adams DR, et al. Efficacy of postexposure prophylaxis after intravaginal exposure of pig-tailed macaques to a human-derived retrovirus (human immunodeficiency virus type 2). J Virol. 2000;74(20):9771–5.
Tsai CC, Emau P, Follis KE, et al. Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment. J Virol. 1998;72(5):4265–73.
Cardo DM, Culver DH, Ciesielski CA, et al. A case–control study of HIV seroconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med. 1997;337(21):1485–1490. https://doi.org/10.1056/NEJM199711203372101
Kahn JO, Martin JN, Roland ME, et al. Feasibility of postexposure prophylaxis (PEP) against human immunodeficiency virus infection after sexual or injection drug use exposure: the San Francisco PEP Study. J Infect Dis. 2001;183(5):707–14. https://doi.org/10.1086/318829
Landovitz RJ, Fletcher JB, Inzhakova G, Lake JE, Shoptaw S, Reback CJ. A novel combination HIV prevention strategy: post-exposure prophylaxis with contingency management for substance abuse treatment among methamphetamine-using men who have sex with men. AIDS Patient Care STDS. 2012;26(6):320–8. https://doi.org/10.1089/apc.2011.0432
Schechter M, do Lago RF, Mendelsohn AB, Moreira RI, Moulton LH, Harrison LH. Behavioral impact, acceptability, and HIV incidence among homosexual men with access to postexposure chemoprophylaxis for HIV. J Acquir Immune Defic Syndr. 2004;35(5):519–525.
Bailey AC, Fisher M. Current use of antiretroviral treatment. Br Med Bull. 2008;87:175–92. https://doi.org/10.1093/bmb/ldn032
Panlilio AL, Cardo DM, Grohskopf LA, Heneine W, Ross CS. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep. 2005;54(RR-9):1–17.
Smith DK, Grohskopf LA, Black RJ, et al. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Services. MMWR Recomm Rep. 2005;54(RR-2):1–20.
Pinkerton SD, Martin JN, Roland ME, Katz MH, Coates TJ, Kahn JO. Cost-effectiveness of postexposure prophylaxis after sexual or injection-drug exposure to human immunodeficiency virus. Arch Intern Med. 2004;164(1):46–544. https://doi.org/10.1001/archinte.164.1.46
Pinkerton SD, Martin JN, Roland ME, Katz MH, Coates TJ, Kahn JO. Cost-effectiveness of HIV postexposure prophylaxis following sexual or injection drug exposure in 96 metropolitan areas in the United States. AIDS. 2004;18(15):2065–73.
Donnell D, Mimiaga MJ, Mayer K, Chesney M, Koblin B, Coates T. Use of non-occupational post-exposure prophylaxis does not lead to an increase in high risk sex behaviors in men who have sex with men participating in the EXPLORE trial. AIDS Behav. 2010;14(5):1182–9. https://doi.org/10.1007/s10461-010-9712-1
Martin JN, Roland ME, Neilands TB, et al. Use of postexposure prophylaxis against HIV infection following sexual exposure does not lead to increases in high-risk behavior. AIDS. 2004;18(5):787–92.
García-Lerma JG, Cong M, Mitchell J, et al. Intermittent prophylaxis with oral truvada protects macaques from rectal SHIV infection. Sci Transl Med. 2010;2(14):14ra4. https://doi.org/10.1126/scitranslmed.3000391
Radzio J, Aung W, Holder A, et al. Prevention of vaginal SHIV transmission in macaques by a coitally-dependent truvada regimen. Ambrose Z, ed. PLoS ONE. 2012;7(12):e50632. https://doi.org/10.1371/journal.pone.0050632
Curtis KA, Kennedy MS, Luckay A, et al. Delayed maturation of antibody avidity but not seroconversion in Rhesus Macaques infected with simian HIV during oral pre-exposure prophylaxis. JAIDS J Acquir Immune Defic Syndr. 2011;57(5):355–62. https://doi.org/10.1097/QAI.0b013e3182234a51
Tsai CC, Follis KE, Sabo A, et al. Prevention of SIV infection in macaques by (R)-9-(2-phosphonylmethoxypropyl)adenine. Science. 1995;270(5239):1197–9. https://doi.org/10.1126/SCIENCE.270.5239.1197
Grant RM. Antiretroviral agents used by HIV-uninfected persons for prevention: pre- and postexposure prophylaxis. Clin Infect Dis. 2010;50(s3):S96–101. https://doi.org/10.1086/651479
Fuller CM, Galea S, Blaney S, et al. Explaining the relationship between race/ethnicity and pharmacy purchased syringes among injection drug users in New York City. Ethn Dis. 2004;14(4):589–96.
Amesty S, Crawford ND, Nandi V, et al. Evaluation of pharmacy-based HIV testing in a high-risk New York City Community. AIDS Patient Care STDS. 2015;29(8):437–44. https://doi.org/10.1089/apc.2015.0017.
Crawford ND, Amesty S, Rivera AV, Harripersaud K, Turner A, Fuller CM. Randomized, community-based pharmacy intervention to expand services beyond sale of sterile syringes to injection drug users in pharmacies in New York City. Am J Public Health. 2013;103(9):1579–82. https://doi.org/10.2105/AJPH.2012.301178
Crawford ND, Rudolph AE, Jones K, Fuller C. Differences in Self-reported discrimination by primary type of drug used among New York City drug users. Am J Drug Alcohol Abuse. 2012;38(6):588–92. https://doi.org/10.3109/00952990.2012.673664
Friedland BA, Sprague L, Nyblade L, et al. Measuring intersecting stigma among key populations living with HIV: implementing the people living with HIV Stigma Index 2.0. J Int AIDS Soc. 2018. https://doi.org/10.1002/jia2.25131
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Association; 2013. https://doi.org/10.1176/appi.books.9780890425596
Anthony J, Vlahov D, Celentano D, et al. Self-report interview data for a study of HIV-1 infection among intravenous drug users: description of methods and preliminary evidence on validity. J Drug Issues. 1991;21(4):739.
Darke S. Self-report among injecting drug users: a review. Drug Alcohol Depend. 1998;51(3):253–63.
We would like to thank the study participants for sharing their experiences, and the study staff for their hard work. This research was sponsored by the National Institute on Drug Abuse, R01DA030253. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the funders.
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Lewis, C.F., Lekas, H., Rivera, A. et al. Pharmacy PEP Access Intervention Among Persons Who Use Drugs in New York City: iPEPcare Study—Rethinking Biomedical HIV Prevention Strategies. AIDS Behav (2020). https://doi.org/10.1007/s10461-019-02775-3
- Drug use
- Structural intervention