Skip to main content

Advertisement

Log in

Beliefs Associated with Intention to Use PrEP Among Cisgender U.S. Women at Elevated HIV Risk

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Women comprise 19% of those newly diagnosed with HIV in the U.S. There is a wide gap between recommended use of pre-exposure prophylaxis (PrEP) and actual uptake among women who are eligible for PrEP. In order to identify women’s beliefs and intentions about starting PrEP, a survey, informed by the reasoned action approach, was administered to 160 cisgender PrEP-eligible women, age 18–55, in Philadelphia and New York City. The mean age was 40.2 years (SD = 11.78), 44% had completed high school, 75% were unemployed, and 85% experienced financial instability in the past 3 months. Multivariate linear regression analyses identified sets of behavioral and normative beliefs associated with intention to start PrEP in the next 3 months. Behavioral beliefs reflected views about PrEP benefits such as preventing HIV, and normative beliefs reflected perceptions of support or lack thereof from others including partners, friends, mother, and children. These findings can be used to inform interventions to foster greater PrEP uptake among women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Aaron, E., Blum, C., Seidman, D., Hoyt, M. J., Simone, J., Sullivan, M., & Smith, D. K. (2018). Optimizing delivery of HIV preexposure prophylaxis for women in the United States. AIDS Patient Care and STDs,32(1), 16–23.

    Article  Google Scholar 

  • Auerbach, J. D., Kinsky, S., Brown, G., & Charles, V. (2015). Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk for acquiring HIV. AIDS Patient Care and STDs,29(2), 102–110.

    Article  Google Scholar 

  • Calabrese, S. K., Dovidio, J. F., Tekeste, M., Taggart, T., Galvao, R. W., Safon, C. B., … Kershaw, T. S. (2018). HIV pre-exposure prophylaxis stigma as a multidimensional barrier to uptake among women who attend Planned Parenthood. Journal of Acquired Immune Deficiency Syndromes,79(1), 46–53.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2014). Compendium of evidence-based interventions and best practices for HIV prevention. Retrieved February 24, 2020 from https://www.cdc.gov/hiv/research/interventionresearch/compendium/index.html.

  • Centers for Disease Control and Prevention. (2018a). HIV surveillance report, 2017 (Vol. 29). Retrieved February 24, 2020 from https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2017-vol-29.pdf.

  • Centers for Disease Control and Prevention. (2018b). Preexposure prophylaxis for the prevention of HIV infection in the United States2017 update: A clinical practice guideline. Retrieved February 24, 2020 from https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf.

  • Chapman Lambert, C., Marrazzo, J., Amico, K. R., Mugavero, M. J., & Elopre, L. (2018). PrEParing women to prevent HIV: An integrated theoretical framework to PrEP black women in the United States. Journal of the Association of Nurses in AIDS Care,29(6), 835–848.

    Article  Google Scholar 

  • City of Philadelphia Department of Public Health AIDS Activities Coordinating Office (AACO). (2019). Retrieved February 24, 2020 from https://www.phila.gov/media/20191101092716/HIV_10_30_2019_FINAL_web.pdf.

  • Collier, K. L., Colarossi, L. G., & Sanders, K. (2017). Raising awareness of pre-exposure prophylaxis (PrEP) among women in New York City: Community and provider perspectives. Journal of Health Communication,22(3), 183–189.

    Article  Google Scholar 

  • Committee on Gynecologic Practice. (2014). Committee Opinion No. 595: Preexposure prophylaxis for the prevention of human immunodeficiency virus. Obstetrics and Gynecology,123(5), 1133–1136.

    Article  Google Scholar 

  • Davis, K. C., Stappenbeck, C. A., Masters, N. T., & George, W. H. (2019). Young women’s experiences with coercive and noncoercive condom use resistance: Examination of an understudied sexual risk behavior. Women’s Health Issues,29(3), 231–237.

    Article  Google Scholar 

  • Eakle, R., Venter, F., & Rees, H. (2018). Pre-exposure prophylaxis (PrEP) in an era of stalled HIV prevention: Can it change the game? Retrovirology,15(1), 29. https://doi.org/10.1186/s12977-018-0408-3

    Article  PubMed  PubMed Central  Google Scholar 

  • Ewing, J. A. (1984). Detecting alcoholism. The CAGE questionnaire. Journal of the American Medical Association,252(14), 1905–1907.

    Article  Google Scholar 

  • Fishbein, M. (2000). The role of theory in HIV prevention. AIDS Care,12(3), 273–278.

    Article  Google Scholar 

  • Fishbein, M., & Ajzen, I. (2010). Predicting and changing behavior: The reasoned action approach. London: Psychology Press (Taylor & Francis).

    Google Scholar 

  • Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The behavioral model for vulnerable populations: Application to medical care use and outcomes for homeless people. Health Services Research,34(6), 1273–1302.

    PubMed  PubMed Central  Google Scholar 

  • Ghanem, K. G., Hutton, H. E., Zenilman, J. M., Zimba, R., & Erbelding, E. J. (2005). Audio computer assisted self interview and face to face interview modes in assessing response bias among STD clinic patients. Sexually Transmitted Infections,81(5), 421–425.

    Article  Google Scholar 

  • Goparaju, L., Experton, L. S., Praschan, N. C., Warren-Jeanpiere, L., Young, M. A., & Kassaye, S. (2015). Women want pre-exposure prophylaxis but are advised against it by their HIV-positive counterparts. Journal of AIDS & Clinical Research,6(11), 1–10.

    Article  Google Scholar 

  • Goparaju, L., Praschan, N. C., Warren-Jeanpiere, L., Experton, L. S., Young, M. A., & Kassaye, S. (2017). Stigma, partners, providers and costs: Potential barriers to PrEP uptake among US women. Journal of AIDS & Clinical Research,8(9), 730. https://doi.org/10.4172/2155-6113.1000730

    Article  Google Scholar 

  • Huang, Y. A., Zhu, W., Smith, D. K., Harris, N., & Hoover, K. W. (2018). HIV preexposure prophylaxis, by race and ethnicity—United States, 2014–2016. Morbity & Mortality Weekly Report,67(41), 1147–1150.

    Article  Google Scholar 

  • Jayakumaran, J. S., Aaron, E., Gracely, E. J., Schriver, E., & Szep, Z. (2016). Knowledge, attitudes, and acceptability of pre-exposure prophylaxis among individuals living with HIV in an urban HIV clinic. PLoS ONE,11(2), e0145670. https://doi.org/10.1371/journal.pone.0145670.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jemmott, L. S., & Jemmott, J. B. (1991). Applying the theory of reasoned action to AIDS risk behavior: Condom use among black women. Nursing Research,40, 228–234.

    Article  Google Scholar 

  • Jemmott, L. S., Jemmott, J. B., & O’Leary, A. (2007). Effect on sexual risk behavior and STD rate of brief HIV/STD prevention interventions for African American women in primary care settings. American Journal of Public Health,97(6), 1034–1040.

    Article  Google Scholar 

  • Koren, D. E., Nichols, J. S., & Simoncini, G. M. (2018). HIV pre-exposure prophylaxis and women: Survey of the knowledge, attitudes, and beliefs in an urban obstetrics/gynecology clinic. AIDS Patient Care and STDs,32(12), 490–494.

    Article  Google Scholar 

  • McKleroy, V. S., Galbraith, J. S., Cummings, B., Jones, P., Harshbarger, C., Collins, C., … ADAPT Team. (2006). Adapting evidence-based behavioral interventions for new settings and target populations. AIDS Education and Prevention,18(supp), 59–73.

    Article  Google Scholar 

  • Namey, E., Agot, K., Ahmed, K., Odhiambo, J., Skhosana, J., Guest, G., & Corneli, A. (2016). When and why women might suspend PrEP use according to perceived seasons of risk: Implications for PrEP-specific risk-reduction counselling. Culture, Health & Sexuality,18(9), 1081–1091.

    Article  Google Scholar 

  • New York City Department of Health and Mental Hygiene. (2017). New York City HIV/AIDS annual surveillance statistics. Retrieved February 24, 2020 from https://www1.nyc.gov/assets/doh/downloads/pdf/dires/hiv-surveillance-annualreport-2017.pdf.

  • Project Inform: California Department of Public Health October (Producer). (2018). Women, PrEP and sexual health. Available on Vimeo. Retrieved February 24, 2020 from https://vimeo.com/186448201.

  • Siegler, A. J., Mouhanna, F., Gile, R. M., Yeung, H., Jones, J., Guest, J. L., … Sullivan, P. S. (2018). Distribution of active PrEP prescriptions and the PrEP-to-need ratio, US, Q2 2017. Paper presented at the Conference on Retroviruses and Opportunistic Infections, Boston, MA. Retrieved February 24, 2020 from http://www.croiconference.org/sites/default/files/posters-2018/1430_Siegler_1022LB.pdf.

  • U.S. Food and Drug Administration. (2012). FDA approves first drug for reducing the risk of sexually acquired HIV infection. Retrieved February 24, 2020 from https://wayback.archive-it.org/7993/20170112032741/http:/www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312210.htm.

  • Walters, S. M., Reilly, K. H., Neaigus, A., & Braunstein, S. (2017). Awareness of pre-exposure prophylaxis (PrEP) among women who inject drugs in NYC: The importance of networks and syringe exchange programs for HIV prevention. Harm Reduction Journal,14, 40. https://doi.org/10.1186/s12954-017-0166-x

    Article  PubMed  PubMed Central  Google Scholar 

  • Williams, D. R. (2002). Racial/ethnic variations in women’s health: The social embeddedness of health. American Journal of Public Health,92(4), 588–597.

    Article  Google Scholar 

  • Wingood, G. M., & DiClemente, R. J. (2000). Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Education & Behavior,27(5), 539–565.

    Article  Google Scholar 

  • Wingood, G. M., Dunkle, K., Camp, C., Patel, S., Painter, J. E., Rubtsova, A., & DiClemente, R. J. (2013). Racial differences and correlates of potential adoption of preexposure prophylaxis: Results of a national survey. Journal of Acquired Immune Deficiency Syndromes,63(Suppl. 1), S95–101.

    Article  Google Scholar 

  • Zhang, C., McMahon, J., Simmons, J., Brown, L. L., Nash, R., & Liu, Y. (2019). Suboptimal HIV pre-exposure prophylaxis awareness and willingness to use among women who use drugs in the United States: A systematic review and meta-analysis. AIDS and Behavior,23(10), 2641–2653.

    Article  Google Scholar 

Download references

Acknowledgements

Anne M. Teitelman and Deepti Chittamuru have contributed equally to this work. The authors thank the participants who agreed to take part in this research and the members of our Community Consulting Group. The authors also thank the outstanding staff who made this work possible.

Funding

This study was funded by 1R34MH108437-01A1 (PI: A. Teitelman) and P30 AI 045008 (PI: J. Hoxie).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anne M. Teitelman.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures were performed in accordance with the ethical standards of the institutional research committee (University of Pennsylvania Institutional Review Board Protocol # 825256 and New York Blood Center IRBNet # is 917035) and NIH (Certificate of Confidentiality from NIH # CC-MH-16-257) and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Teitelman, A.M., Chittamuru, D., Koblin, B.A. et al. Beliefs Associated with Intention to Use PrEP Among Cisgender U.S. Women at Elevated HIV Risk. Arch Sex Behav 49, 2213–2221 (2020). https://doi.org/10.1007/s10508-020-01681-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-020-01681-3

Keywords

Navigation