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An Exploration of Pre-exposure Prophylaxis (PrEP) Initiation Among Women Who Inject Drugs

Archives of Sexual Behavior volume 49, pages 2205–2212 (2020)Cite this article

Abstract

Pre-exposure prophylaxis (PrEP) is an effective but understudied tool for preventing HIV among women who inject drugs (WWID). This article is the first to explore WWID’s rationale for PrEP initiation (or refusal) in a real-world setting. Purposive sampling was used to recruit 25 WWID, participating in a PrEP demonstration project operating within a syringe services program, based on whether they initiated or declined PrEP care. Content analysis of qualitative interviews was used to explore decisions to initiate PrEP (or not). We found that WWID view HIV as severe, perceive themselves to be susceptible to HIV, and believe PrEP is beneficial for HIV prevention. For some, however, real and perceived barriers outweighed benefits, leading to decisions not to initiate PrEP. Barriers included HIV stigma, fear of side effects, and needing assurance that PrEP care will be available long-term. Despite viewing PrEP as an important HIV prevention tool, not all WWID who were offered PrEP initiated it. For these women, supports to buffer perceived barriers to initiation and access to post-exposure prophylaxis may be warranted. For women who initiate, it is possible that adherence will wane if perceived risk does not remain high. Research to understand PrEP persistence is needed.

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Acknowledgements

The authors thank the participants, Prevention Point Philadelphia especially former/current staff members: Jennie Coleman, Jade McKnight, Samantha Sitrin, Rose Lurano, Elby Katumkeeryil, and the dedicated research staff: Brogan Piecara, Bolutife Odeniyi, Brenna Aumaeir-Aredas, Dr. Annette Gadebeku, and Dr. Alicia Tucker.

Funding

This study was supported by the National Institute on Drug Abuse (1R21DA043417-01A1) and the American STD Association Developmental Award Program.

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Authors and Affiliations

  1. Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St., Room 454, Philadelphia, PA, 19104, USA

    Marisa Felsher & Alexis M. Roth

  2. Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA

    Eliza Ziegler

  3. Department of Medicine, University of California, San Diego, San Diego, CA, USA

    Laramie R. Smith

  4. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Susan G. Sherman

  5. Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA

    K. Rivet Amico

  6. Public Health Management Corporation Care Clinic, Philadelphia, PA, USA

    Rachel Fox

  7. Prevention Point Philadelphia, Philadelphia, PA, USA

    Kayla Madden

Authors
  1. Marisa Felsher
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  2. Eliza Ziegler
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  3. Laramie R. Smith
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  4. Susan G. Sherman
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  8. Alexis M. Roth
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Correspondence to Alexis M. Roth.

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Ethical Approval

Study procedures were approved by the Drexel University Institutional Review Board (ID 1704005331) and the Prevention Point Philadelphia Executive Board.

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

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The authors declare that they have no conflict of interest.

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Felsher, M., Ziegler, E., Smith, L.R. et al. An Exploration of Pre-exposure Prophylaxis (PrEP) Initiation Among Women Who Inject Drugs. Arch Sex Behav 49, 2205–2212 (2020). https://doi.org/10.1007/s10508-020-01684-0

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  • DOI: https://doi.org/10.1007/s10508-020-01684-0

Keywords

  • HIV
  • Pre-exposure prophylaxis
  • Women who inject drugs
  • Health belief model