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Living at the Confluence of Stigmas: PrEP Awareness and Feasibility Among People Who Inject Drugs in Two Predominantly Rural States

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Abstract

We explored knowledge, beliefs, and acceptability of pre-exposure prophylaxis (PrEP) for HIV prevention with reference to stigma among people who inject drugs (PWID) in two predominately rural U.S. states. We conducted interviews with 65 current or former PWID aged 18 years or older and living in Arizona or Indiana. Most (63%) of the interviewees were not aware of PrEP. They often confused PrEP with HIV treatment, and many believed that PrEP was only for sexual risk or gay sexual risk. Once they understood that PrEP was recommended for PWID, the participants held a positive view of PrEP and felt that a once-daily pill was feasible. Experiences of stigma about drug use remained a crucial barrier to accessing healthcare and PrEP. This was often linked with anticipated or expressed homophobia. PrEP interventions among PWID must focus on education and the confluence of stigmas in which PWID find themselves when considering PrEP.

Resumen

Exploramos el conocimiento, las creencias y la aceptabilidad de la profilaxis previa a la exposición (PrEP) para la prevención del VIH con referencia al estigma entre las personas que inyectan drogas (PWID) en dos Estados Unidos predominantemente rurales. estados. Realizamos entrevistas con 65 PWID actuales o anteriores de 18 años o más y viviendo en Arizona o Indiana. Más (63%) de los entrevistados no estaban al tanto de la PrEP. A menudo confundieron la PrEP con el tratamiento del VIH, y muchos creían que la PrEP era sólo por riesgo sexual o riesgo sexual gay. Una vez que entendieron que la PrEP se recomendaba para PWID, los participantes tenían una visión positiva de la PrEP y sentían que una vez-píldora diaria era factible. Las experiencias de estigma sobre el consumo de drogas siguieron siendo una barrera crucial para acceder a la atención médica y a la PrEP. Esto a menudo estaba relacionado con la homofobia anticipada o expresada. Las intervenciones de la PrEP entre PWID deben centrarse en la educación y la confluencia de estigmas en los que PWID se encuentra al considerar la PrEP.

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Funding

This study was funded in part by the Indiana University Addictions Crisis Grand Challenge Initiative.

Author information

Authors and Affiliations

  1. Department of Community and Health Systems, Indiana University School of Nursing, 1125 Atwater Ave, Bloomington, IN, 47401, USA

    Gregory Carter

  2. Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA

    Gregory Carter

  3. School of Nursing, Indiana University, Bloomington, IN, USA

    Gregory Carter

  4. Southwest Institute for Research On Women, College of Social and Behavioral Science, University of Arizona, Tucson, AZ, USA

    Beth Meyerson

  5. Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA

    Beth Meyerson & Patrick Rivers

  6. Institute for LGBT Studies, University of Arizona, Tucson, AZ, USA

    Beth Meyerson

  7. Department of Health Behavior, College of Public Health, University of Kentucky, Lexington, KY, USA

    Richard Crosby

  8. Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA

    Carrie Lawrence

  9. Harm Reduction Foster Care Advocate, Tucson, AZ, USA

    Summer Dawn Cope, Steven Levin & Christopher Thomas

  10. Indiana Recovery Alliance, Bloomington, IN, USA

    David DeBruicker, Whitney Meeks, Brooklyne Turner & Chris Abert

  11. Sonoran Prevention Works, Phoenix, AZ, USA

    Steven Levin, Christopher Thomas, Haley Coles & Alicia Allen

  12. Southwest Recovery Alliance, Phoenix, AZ, USA

    Chris Abert

  13. College of Public Health, University of Arizona, Tucson, AZ, USA

    Eduardo Gonzalez-Fagoaga

  14. Southern Arizona AIDS Foundation, Tucson, AZ, USA

    Ravi Grivois-Shah

Authors
  1. Gregory Carter
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Contributions

All authors contributed to the study conception and design. Material preparation and analysis were performed by GC, BM, CL, CA, WM, BT, RC, PR. The first draft of the manuscript was written by GC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Gregory Carter.

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The authors have no relevant financial or non-financial interests to disclose.

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Approval was obtained from the University of Arizona Institutional Review Board.

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Informed consent was obtained from all individual participants included in the study.

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Carter, G., Meyerson, B., Rivers, P. et al. Living at the Confluence of Stigmas: PrEP Awareness and Feasibility Among People Who Inject Drugs in Two Predominantly Rural States. AIDS Behav 25, 3085–3096 (2021). https://doi.org/10.1007/s10461-021-03304-x

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