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The Influence of PrEP-Related Stigma and Social Support on PrEP-Use Disclosure among Women Who Inject Drugs and Social Network Members

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Abstract

Pre-exposure prophylaxis (PrEP) is a promising but underutilized HIV prevention strategy for Women who Inject Drugs (WWID). Stigma and disclosure concerns have been key barriers to PrEP use among women in PrEP efficacy trials. Social support has been found to buffer against some PrEP stigma, though these factors have been largely unexplored among WWID. Investigating how WWID disclose PrEP use is important given evidence that disclosure is associated with higher adherence. We aimed to identify the impact of stigma and support on PrEP disclosure within social networks of WWID participating in a PrEP demonstration project in Philadelphia, PA, USA. PrEP-using WWID ≥ 18 years completed social network surveys. Generalized estimating equations were used to account for the correlation of network structure. Thirty-nine WWID (i.e. egos) named an average of 9.5 ± 3.3 network members (i.e. alters), for a total sample of 371 unique relationships. Egos disclosed their PrEP use to an average of 4.0 alters (SD = 2.8). Related to PrEP stigma, participants had 0.4 times decreased odds of PrEP disclosure with alters who would disapprove of them taking PrEP (95% CI: 0.1–0.9). Related to support, participants had 2.5 times higher odds of disclosure among peers who could provide PrEP advice (95% CI: 1.0–6.0). Interventions that increase social support and decrease stigma are pivotal for increasing PrEP use disclosure among WWID.

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Funding

This work was supported by NIH / NICHD Grant Award R25HD079352 to Duke University.

Author information

Authors and Affiliations

  1. Division of Infectious Diseases, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA

    Marisa Felsher & Oluwaseun Falade-Nwulia

  2. Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, 833 Chestnut Street, Philadelphia, PA, 19107, USA

    Karley Dutra

  3. Department of Obstetrics and Gynecology, Stanford Hospital and Clinics, 300 Pasteur Dr, Stanford, CA, 94305, USA

    Brent Monseur

  4. Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA

    Alexis M. Roth

  5. Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA

    Carl Latkin

Authors
  1. Marisa Felsher
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  2. Karley Dutra
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  3. Brent Monseur
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  4. Alexis M. Roth
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  5. Carl Latkin
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  6. Oluwaseun Falade-Nwulia
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Contributions

Study conception and design was conceptualized by MF, AR, and OF-N. Material preparation, data collection and analysis were performed by MF. The first draft of the manuscript was written by MF, KD, BM, AR, CL and OF-N. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Marisa Felsher.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

Research was approved by the institutional review boards at Drexel University and Prevention Point Philadelphia.

Consent to Participate

This study was performed in line with the principles of the Declaration of Helsinki. Verbal informed consent was obtained prior to data collection.

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Participants consented to the publication of their de-identified data.

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Felsher, M., Dutra, K., Monseur, B. et al. The Influence of PrEP-Related Stigma and Social Support on PrEP-Use Disclosure among Women Who Inject Drugs and Social Network Members. AIDS Behav 25, 3922–3932 (2021). https://doi.org/10.1007/s10461-021-03312-x

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  • DOI: https://doi.org/10.1007/s10461-021-03312-x

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