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Factors Associated with Intention to Initiate Pre-exposure Prophylaxis in Cisgender Women at High Behavioral Risk for HIV in Washington, D.C.


Pre-exposure prophylaxis (PrEP) for HIV prevention is underutilized by cisgender women at risk for HIV in the USA. Published research on PrEP initiation among cisgender women at risk for HIV focuses on identifying barriers and facilitators associated with intention to initiate, but few apply a behavioral theoretical lens to understand the relative importance of these diverse factors. This study provides a theoretically grounded view of the relative importance of factors associated with intention to initiate PrEP. We conducted an anonymous, cross-sectional survey of 1437 cisgender women seeking care at family planning and sexual health clinics to evaluate hypothesized barriers and facilitators of PrEP initiation. We categorized cisgender women with ≥ 3 behavioral risk-factors as “high-risk” for HIV acquisition; 26.9% (N = 387) met high-risk criterion. Among cisgender women in the high-risk sample, the majority were Black and single. Perceived risk of HIV acquisition was low and 13.7% reported intention to initiate PrEP. Positive attitudes toward PrEP, self-efficacy, perceived support from medical providers and social networks, and prior discussion about PrEP with medical providers were associated with intention to initiate PrEP; stigma was negatively associated. Background characteristics (other than age), risk factors for HIV acquisition, prior awareness of PrEP, and perceived risk of HIV were not associated with uptake intention. These findings support interventions that center on the role of providers in the provision of PrEP and on social networks in destigmatization of PrEP use.

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  1. There were no statistical differences in demographic characteristics (such as race, relationship status, educational level, income, employment status, and insurance status) between women with missing information on intention to initiate PrEP and those with complete information.


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The authors would like to thank Drs. Ron Migues and Patricia Tanjutco from MedStar Health Institute for their administrative support and the clinical teams at DC Health and MedStar Washington Hospital Center Family Planning and Preventative Care for their participation and support.


Data reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001409, the National Institute on Drug Abuse under Award Number 1K01DA050496-01A1a, and an Investigator Sponsored Research Award from Gilead Sciences (ISR-17-10227). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Correspondence to Rachel K. Scott.

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The authors report no conflicts of interest.

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IRB approval was obtained from the respective IRBs prior to initiation of the study and maintained throughout IRB#s 2017-0870 and 2017–25. Written consent was obtained from all participants.

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Scott, R.K., Hull, S.J., Huang, J.C. et al. Factors Associated with Intention to Initiate Pre-exposure Prophylaxis in Cisgender Women at High Behavioral Risk for HIV in Washington, D.C.. Arch Sex Behav 51, 2613–2624 (2022).

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