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


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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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.


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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Correspondence to Alexis M. Roth.

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

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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).

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