Awareness of pre-exposure prophylaxis (PrEP) among women who inject drugs in NYC: the importance of networks and syringe exchange programs for HIV prevention

• Published in: Harm reduction journal Vol. 14; no. 1; pp. 40 - 12
• Main Authors: Walters, Suzan M, Reilly, Kathleen H, Neaigus, Alan, Braunstein, Sarah
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29-06-2017; BioMed Central; BMC
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; Age; AIDS; Binge drinking; Binge Drinking - complications; Binge Drinking - epidemiology; Care and treatment; Conversation; Cross-Sectional Studies; Demographic variables; Demographics; Diagnosis; Dosage and administration; Drinking; Drug abuse; Drug use; Drug Users - psychology; Drugs; Exchanging; Exposure; Female; Gender; Harm reduction; Health care; Health risk assessment; Health risks; HIV; HIV infections; HIV Infections - prevention & control; HIV Infections - transmission; Human immunodeficiency virus; Humans; Injectable anesthetics; Injection; Injection drug use; Logistic regression; Middle Aged; Needle exchange programs; Needle Sharing; Needle-Exchange Programs - organization & administration; New York City; Pre-exposure prophylaxis; Prevention; Prophylaxis; Race; Regression analysis; Risk analysis; Risk Factors; Risk taking; Safe Sex; Sex; Sex work; Social interactions; Social Networking; Social networks; Social organization; Socioeconomic Factors; Statistical analysis; Statistical tests; Substance Abuse, Intravenous - complications; Syringe exchange programs; Womens health; Young Adult; United States > US; Injection drug use; Gender; HIV; Sex work; Pre-exposure prophylaxis; Syringe exchange programs
• ISSN: 1477-7517; 1477-7517
• DOI: 10.1186/s12954-017-0166-x

Women who inject drugs (WWID) are at heightened risk for HIV due to biological, behavioral, and structural factors. Pre-exposure prophylaxis (PrEP) could aid in HIV prevention for WWID. However, little is known about WWID awareness of PrEP, which is a necessary step that must occur before PrEP uptake. We report factors associated with greater awareness among WWID to identify efficient means of awareness dissemination.
Data from the 2015 National HIV Behavioral Surveillance (NHBS) system cycle on injection drug use collected in New York City (NYC) were used. Bivariable analyses, using chi-squared statistics, were conducted to examine correlates of awareness of PrEP with socio-demographic, behavioral, and health care variables. Multivariable logistic regression was used to estimate adjusted associations and determine differences in awareness of PrEP.
The analysis consisted of 118 WWID. Awareness of PrEP was relatively low (31%), and risk factors were high. In the last 12 months, almost two thirds (65%) reported condomless sex, approximately one third (31%) reported transactional sex, and one third (32%) reported sharing injection equipment. In multivariable logistic regression, increased PrEP awareness was associated with reported transactional sex (AOR 3.32, 95% CI 1.22-9.00) and having a conversation about HIV prevention at a syringe exchange program (SEP) (AOR 7.61, 95% CI 2.65-21.84). We did not find race, education, household income, age, binge drinking, or sexual identity to be significantly associated with PrEP awareness.
Large proportions of WWID were unaware of PrEP. These findings suggest that social networks (specifically sex work and SEP networks) are an efficient means for disseminating messaging about prevention materials such as PrEP. We recommend that SEP access increase, SEP processes be adopted in other health care settings, and WWID networks be utilized to increase PrEP awareness.