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Irie WC, Calabrese SK, Mayer KH, Geng EH, Blackstock O, Marcus JL. Social and structural factors associated with interest in HIV preexposure prophylaxis among Black women in the United States. AIDS Care 2024; 36:672-681. [PMID: 38176016 PMCID: PMC10994725 DOI: 10.1080/09540121.2023.2299338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
In a nationwide sample of cisgender Black women in the US, we assessed the associations between social and structural factors and interest in using HIV preexposure prophylaxis (PrEP). Among 315 respondents, 62.2% were interested in PrEP if it were provided for free. Positive social norms surrounding PrEP, including injunctive norms (perceived social acceptability of PrEP use) and descriptive norms (perceived commonality of PrEP use), were positively associated with interest in using PrEP. Concerns about HIV infection, recently visiting a health care provider, and comfort discussing PrEP with a provider were also positively associated with interest in using PrEP. Anticipating PrEP disapproval from others was negatively associated with interest in PrEP. Although PrEP can promote autonomy and personal discretion, Black women's PrEP-related decisions occur in a complex social environment. Black women may benefit from interventions to promote positive norms and attitudes surrounding PrEP at the community level and empower them in discussions with their providers about PrEP.
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Affiliation(s)
- Whitney C. Irie
- Boston College School of Social Work, Chestnut Hill, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Sarah K. Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, D.C., USA
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, D.C., USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - Elvin H. Geng
- Division of Infectious Diseases, Washington University in St Louis, St. Louis, MO, USA
| | | | - Julia L. Marcus
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Bonner CP, Minnis AM, Ndirangu JW, Browne FA, Speizer I, Nyblade L, Ahmed K, Wechsberg WM. The Importance of the Individual in PrEP Uptake: Multilevel Correlates of PrEP Uptake Among Adolescent Girls and Young Women in Tshwane, South Africa. AIDS Behav 2023; 27:4124-4130. [PMID: 37439915 DOI: 10.1007/s10461-023-04126-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 07/14/2023]
Abstract
Adolescent girls and young women (AGYW) account for 25% of new HIV infections in South Africa. Pre-exposure prophylaxis (PrEP) is approved by the South African Government, but the factors that promote PrEP uptake among AGYW are not well understood. This study examines multilevel factors associated with PrEP uptake among AGYW in six clinic catchment areas in Tshwane (Pretoria), South Africa. After consent/assent, PrEP-eligible AGYW (n = 448) completed a questionnaire assessing factors at the individual, network/interpersonal, and community levels and were prescribed PrEP in study clinics, if interested. A multivariable model, adjusting for clustering, assessed factors associated with PrEP uptake over a 9-month period. At the individual level, multiple partners in the past 3 months (OR = 0.47), perceived risk of HIV (OR = 0.71), and PrEP-related shame (OR = 0.63) were correlated with lower odds of PrEP uptake (ps ≤ 0.05). The findings highlight modifiable factors that should be addressed to support PrEP uptake efforts.
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Affiliation(s)
- Courtney Peasant Bonner
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| | | | - Jacqueline W Ndirangu
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Felicia A Browne
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Ilene Speizer
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Laura Nyblade
- Women's Global Health Imperative, RTI International, NC, USA
| | - Khatija Ahmed
- Setshaba Research Centre, Soshanguve, South Africa
- Faculty of Health Sciences, Dept of Medical Microbilogy, University of Pretoria, Pretoria, South Africa
| | - Wendee M Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
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Irie W, Mahone A, Nakka R, Ghebremichael M. Confidence in Ability to Communicate With Sexual Partners About PrEP Among Black Cisgender Women. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:333-346. [PMID: 37843905 DOI: 10.1521/aeap.2023.35.5.333] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
This study explored the factors associated with Black women's confidence in their ability to engage male sexual partners in discussions about PrEP. Communication about PrEP with male partners is an important, yet minimally explored, outcome in PrEP research among Black women in heterosexual partnerships. Among 315 respondents, results show significant differences in anticipated stigma and interest in PrEP between a binary outcome variable being confident and not-confident discussing PrEP with sexual partners. Further, factors such as employment, worrying about HIV infection, interest in taking oral PrEP, subjective norms, injunctive norms, and descriptive norms were associated with Black women's higher odds of confidence in their ability to engage sexual partners about PrEP. Conversely, PrEP disapproval and stigma resulted in lower odds of Black women's confidence in their ability to engage sexual partners about PrEP. Results indicate the need for continued investigation of confidence and, relatedly, communication about PrEP among heterosexual couples and communitylevel interventions normalizing PrEP discussions and uptake.
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Affiliation(s)
- Whitney Irie
- Boston College School of Social Work, Chestnut Hill, Massachusetts, and The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Anais Mahone
- School of Social Work, Rutgers University, New Brunswick, New Jersey
| | - Raja Nakka
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts
| | - Musie Ghebremichael
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School, Cambridge, Massachusetts
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Guo Z, Chen Y, Zhang Y, Ding C, Li M, Xu L, Jin J. Associations among risk perception, health efficacy, and health behaviors for cardiovascular disease: an application of risk perception attitude framework. Front Cardiovasc Med 2023; 10:1201789. [PMID: 37771673 PMCID: PMC10525708 DOI: 10.3389/fcvm.2023.1201789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023] Open
Abstract
Background There is currently a pervasive prevalence of cardiovascular disease (CVD) risk worldwide and an inadequate amount of action is being taken to promote healthy lifestyle habits. The risk perception attitude (RPA) framework, which classifies individuals based on their risk perception and efficacy belief, enables us to predict their preventive behaviors. We applied the RPA framework to analyze CVD prevention behaviors among Chinese adults and extended its application to CVD objective risk. Methods A cross-sectional survey was performed in two sites in Zhejiang Province, from March to August 2022, which contained self-reported CVD risk perception, objective CVD risk, efficacy belief, physical activity, healthy diet, and covariates. We used the RPA framework to categorize participants into four groups, then analysis was conducted to estimate inter-group differences in healthy behaviors. We further conducted a hierarchical logistic regression analysis with individuals' health behaviors as the dependent variable, using three blocks of independent variables. Results Among 739 participants, healthy physical activity and healthy diet had significant differences among four RPA groups, post hoc tests clarified that the proportion of respondents with healthy PA in the responsive group (61.6%) was significantly higher than that in the other three groups. Risk perception and efficacy belief significantly predicted health behavior against CVD; the relationship between absolute CVD risk and health behavior was moderated by efficacy belief. Conclusions Early CVD risk screening is crucial, but tailored support and a proper understanding of personal risk are essential to promote healthy behaviors. Developing communication and behavioral counseling intervention strategies on the basis of the RPA framework has the potential to promote healthy behaviors for CVD prevention.
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Affiliation(s)
- Zhiting Guo
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, China
| | - Yun Chen
- Public Health Department, Changxing County People’s Hospital, Huzhou, China
| | - Yuping Zhang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, China
| | - Chuanqi Ding
- Emergency Department, Changxing County People’s Hospital, Huzhou, China
| | - Mei Li
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, China
| | - Linyan Xu
- Nursing Department, Lishui University School of Medicine, Lishui, China
| | - Jingfen Jin
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, China
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Darlington CK, Lipsky RK, Teitelman AM, Koblin BA, Davis A, Walcott M, Compton PA, Tieu HV. HIV risk perception, pre-exposure prophylaxis (PrEP) awareness, and PrEP initiation intention among women who use drugs. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209119. [PMID: 37451517 PMCID: PMC10529693 DOI: 10.1016/j.josat.2023.209119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/16/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Women who use drugs (WWUD) are prime candidates for pre-exposure prophylaxis (PrEP) due to their elevated risk of acquiring HIV through biological, behavioral, and contextual factors. However, PrEP uptake among WWUD remains low. The relationship between unhealthy drug use and correlates of PrEP uptake in this vulnerable population is not well defined. The purpose of this study is to characterize the relationships between specific types and routes of drug use and several precursors of PrEP uptake among WWUD. METHODS The study collected data via a computer-based survey from 233 women living in New York City and Philadelphia who participated in a study designed to develop and pilot a women-focused intervention for PrEP uptake. The sample of cisgender, HIV-negative women were not currently taking PrEP but considered PrEP eligible. This analysis is focused on women's HIV risk perception, PrEP awareness, PrEP initiation intention, and any use of the following drugs: barbiturates, benzodiazepines, crack cocaine, powder cocaine, hallucinogens, heroin, methamphetamines, and prescription opioids. RESULTS Within the three months prior to study enrollment, 63.1 % of participants reported any drug use; 42 % reported polydrug use; 19.8 % had injected drugs; 75 % reported getting high or drunk before sex; and 44 % had been enrolled in drug treatment. Of our total sample, 41.2 % perceived themselves at risk for HIV infection, 41.6 % were aware of PrEP prior to the study, and 62.7 % intended to initiate PrEP after they were informed. When compared to other PrEP-eligible women, women who reported prescription opioid use and polydrug use perceived themselves at higher risk for HIV infection and had higher intention to start PrEP. However, they and women who reported injecting drugs also reported lower awareness of PrEP. CONCLUSION These findings have implications for increasing education about PrEP and the various modes of HIV exposure to support PrEP uptake in this vulnerable population.
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Affiliation(s)
| | | | - Anne M Teitelman
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA; Thomas Jefferson University, College of Nursing, Philadelphia, PA, USA
| | | | - Annet Davis
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Melonie Walcott
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Peggy A Compton
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA; Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Jennings Mayo-Wilson L, Coleman Lewis J, MacCarthy S, Linnemayr S. Assessing behavioral economic biases among young adults who have increased likelihood of acquiring HIV: a mixed methods study in Baltimore, Maryland. AIDS Res Ther 2023; 20:25. [PMID: 37150823 PMCID: PMC10165802 DOI: 10.1186/s12981-023-00521-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/18/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Behavioral economic (BE) biases have been studied in the context of numerous health conditions, yet are understudied in the field of HIV prevention. This aim of this study was to quantify the prevalence of four common BE biases-present bias, information salience, overoptimism, and loss aversion-relating to condom use and HIV testing in economically-vulnerable young adults who had increased likelihood of acquiring HIV. We also qualitatively examined participants' perceptions of these biases. METHODS 43 participants were enrolled in the study. Data were collected via interviews using a quantitative survey instrument embedded with qualitative questions to characterize responses. Interviews were transcribed and analyzed using descriptive statistics and deductive-inductive content analyses. RESULTS 56% of participants were present-biased, disproportionately discounting future rewards for smaller immediate rewards. 51% stated they were more likely to spend than save given financial need. Present-bias relating to condom use was lower with 28% reporting they would engage in condomless sex rather than wait one day to access condoms. Most participants (72%) were willing to wait for condom-supported sex given the risk. Only 35% knew someone living with HIV, but 67% knew someone who had taken an HIV test, and 74% said they often think about preventing HIV (e.g., high salience). Yet, 47% reported optimistically planning for condom use, HIV discussions with partners, or testing but failing to stick to their decision. Most (98%) were also averse (b = 9.4, SD ±.9) to losing their HIV-negative status. Qualitative reasons for sub-optimal condom or testing choices were having already waited to find a sex partner, feeling awkward, having fear, or not remembering one's plan in the moment. Optimal decisions were attributed qualitatively to self-protective thoughts, establishing routine care, standing on one's own, and thinking of someone adversely impacted by HIV. 44% of participants preferred delayed monetary awards (e.g., future-biased), attributed qualitatively to fears of spending immediate money unwisely or needing time to plan. CONCLUSION Mixed methods BE assessments may be a valuable tool in understanding factors contributing to optimal and sub-optimal HIV prevention decisions. Future HIV prevention interventions may benefit from integrating savings products, loss framing, commitment contracts, cues, or incentives.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Department of Health Behavior, Department of Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 310 Rosenau Hall CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
| | - Jessica Coleman Lewis
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Sarah MacCarthy
- Department of Health Behavior, University of Alabama at Birmingham School of Public Health, 1665 University Boulevard, Birmingham, AL, USA
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HIV Risk Perception and Pre-Exposure Prophylaxis (PrEP) Awareness Among Transgender Women from Mexico. AIDS Behav 2023; 27:992-1002. [PMID: 36121550 DOI: 10.1007/s10461-022-03836-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/01/2022]
Abstract
This study aimed to identify factors associated with HIV risk perception among Mexican transgender women (TGW). This cross-sectional survey was conducted online and at a public HIV clinic in Mexico City. Participants were ≥ 18 years old, self-identified as TGW, and reported not living with HIV. They answered questions on sexual behavior, HIV risk perception, and pre-exposure prophylaxis (PrEP) awareness. We performed a multivariate logistic regression to accomplish the study's objective. One hundred ninety-one TGW completed the survey. High HIV risk perception was associated with > 5 sexual partners, condomless receptive anal sex, sex with a male partner(s) of unknown HIV status, and PrEP awareness. Although most TGW reported low HIV risk perception, over half had risk sexual behavior, reflecting inaccurate risk assessment. Future interventions to improve accurate risk perception among TGW should promote HIV transmission and prevention knowledge and increase PrEP awareness and uptake.
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Craddock JB, Franke ND, Kingori C. Associations of Social Network- and Individual-Level Factors with HIV Testing, Condom Use, and Interest in PrEP Among Young Black Women. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2473-2483. [PMID: 35676567 PMCID: PMC9293839 DOI: 10.1007/s10508-022-02306-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/21/2022] [Accepted: 02/04/2022] [Indexed: 06/15/2023]
Abstract
To achieve the 2030 goal of ending the HIV epidemic, we must consider social network- along with individual-level factors related to HIV prevention among young Black women (YBW). This cross-sectional study examined egocentric social network- and individual-level data of 180 YBW aged 18-24. Multivariable logistic regression models were used to study social network characteristics and individual sexual behaviors related to HIV prevention behaviors (e.g., HIV testing, condom use, and interest in preexposure prophylaxis, or PrEP). On average, YBW nominated 11 social network members (SNMs; seven friends, two family members, and one sex partner). About 92% of YBW spoke to at least one SNM about condom use and 58% spoke to at least one SNM about HIV testing. Respondents who spoke to a sex partner about condom use had 70% lower odds of being interested in PrEP, but 2.99 times the odds of reporting condom use during last sex. Odds of being tested for HIV in the prior 3 months were significantly increased by 3.97 times for those who spoke to at least one sex partner about HIV testing. However, odds of being interested in PrEP were significantly decreased by 63% for YBW who were tested for HIV in the prior 3 months. Findings underscore that understanding network- and individual-level factors is crucial in increasing HIV testing, condom use, and interest in PrEP among YBW.
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Affiliation(s)
- Jaih B Craddock
- School of Social Work, University of Maryland Baltimore, 525 W. Redwood St., Baltimore, MD, 20201, USA.
| | - Nancy D Franke
- School of Social Work, University of Maryland Baltimore, 525 W. Redwood St., Baltimore, MD, 20201, USA
| | - Caroline Kingori
- College of Health Sciences and Professions, Ohio University, Athens, OH, USA
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Irie WC, Calabrese SK, Patel RR, Mayer KH, Geng EH, Marcus JL. Preferences for HIV Preexposure Prophylaxis Products Among Black Women in the U.S. AIDS Behav 2022; 26:2212-2223. [PMID: 34985607 DOI: 10.1007/s10461-021-03571-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 01/27/2023]
Abstract
In a nationwide sample of Black women in the U.S., we assessed preferences for HIV preexposure prophylaxis (PrEP) products, including long-acting injectable (LAI) PrEP and once-daily oral PrEP. Among 315 respondents, 32.1% were aware of PrEP and 40.6% were interested in using it; interest increased to 62.2% if PrEP were provided for free. Oral PrEP was the preferred option (51.1%), followed by LAI PrEP (25.7%), vaginal gel (16.5%), and vaginal ring (6.7%). When examining oral and LAI PrEP alone, most (62.7%) preferred oral PrEP. LAI PrEP was more likely to be preferred among respondents with concerns about healthcare costs or PrEP-related stigma, and among those who reported inconsistent condom use and multiple sexual partners. Although most Black women preferred oral PrEP, LAI PrEP may be appealing to a subset with social and structural barriers to PrEP use, such as cost and stigma, and those at increased risk of HIV infection.
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Napolitano MA, Tjaden AH, Bailey CP, DiPietro L, Rimal R. What moves young people? Applying the risk perception attitude framework to physical activity behavior and cardiometabolic risk. Transl Behav Med 2022; 12:742-751. [PMID: 35429404 PMCID: PMC9653003 DOI: 10.1093/tbm/ibac012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Cardiometabolic disease risk factors, including metabolic syndrome and physical inactivity, are prevalent among young adults. However, few young adults are aware of their risk status. The risk perception attitude (RPA) framework was used to categorize participants (n = 456) enrolled in a three-arm randomized controlled weight management trial by their baseline values of cardiometabolic risk perceptions and physical activity self-efficacy. Trial recruitment occurred at two universities from 2015 to 2018 and participants were randomly assigned to one of three weight management interventions: Tailored, Targeted, Control. Cross-sectional and longitudinal analyses were conducted to examine associations between RPA category (i.e., Responsive, Indifferent, Avoidant, Proactive) and physical activity behavior. At baseline, the Responsive group had the highest amount of physical activity (mean [95% CI]: 379.2 [332.6 to 425.8] min/week), the Indifferent group had the lowest (296.7 [261.98 to 331.32] min/week), and the Avoidant/Proactive groups showed intermediate values. Over 6 months, there was a significant interaction between RPA group and intervention arm on change in physical activity adjusted for age, sex, race/ethnicity, baseline body mass index, and baseline moderate-to-vigorous physical activity (p = .017). Among Tailored intervention participants only, the Proactive participants were the only group to have an increase in physical activity (19.97 min/week) and the Indifferent participants had the most significant decrease in physical activity (127.62 min/week). Results suggest the importance of early screening for young adults to help raise awareness of cardiometabolic risk and ultimately support them in health promotion efforts.
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Affiliation(s)
- Melissa A Napolitano
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
- Department of Exercise and Nutrition Sciences, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Ashley Hogan Tjaden
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Caitlin P Bailey
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Loretta DiPietro
- Department of Exercise and Nutrition Sciences, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Rajiv Rimal
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
- Department of Health, Behavior, and Society, Johns Hopkins Blumberg school of Public Health, Baltimore, MD, USA
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Sullivan PS, Siegler AJ. What will it take to meet UNAIDS targets for preexposure prophylaxis users? Curr Opin Infect Dis 2022; 35:1-8. [PMID: 34879049 DOI: 10.1097/qco.0000000000000809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Preexposure prophylaxis (PrEP) is a critical strategy to curb new HIV infections globally. National and global targets have been set for people starting PrEP. However, global PrEP initiations fell short of UNAIDS 2020 targets, and reflection is needed on how we set and meet targets for PrEP use. RECENT FINDINGS Recent literature documents challenges to meeting ambitious goals for PrEP coverage in multiple phases of PrEP: PrEP initiations are limited by gaps in the identification of those who might benefit from PrEP. Conversely, getting PrEP to those who need it most is threatened by inaccurate risk perception and HIV and PrEP stigma. Once people are on PrEP, a substantial number discontinue PrEP in the first year (the 'PrEP Cliff'), a finding that is robust across groups of PrEP users (e.g., women, men who have sex with men, transwomen) and across global prevention settings. Further, PrEP inequities - by which we refer to utilization of PrEP in a specific group that is not commensurate with their epidemic risk - threaten the overall population benefit of PrEP because those at highest risk of acquiring HIV are not adequately protected. SUMMARY To realize global goals for PrEP utilization and impact, we must address multiple points of PrEP delivery programs that address not just PrEP starts, but also retention in PrEP and measurement and accountability to PrEP equity. We call for new approaches to better identify PrEP candidates, suggest additional research to address the known and consistent reasons for PrEP discontinuations, and advocate for metrics to measure and be accountable to PrEP equity.
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Affiliation(s)
- Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Nakamanya S, Kawuma R, Kibuuka D, Kusemererwa S, McCormack S, Ruzagira E, Seeley J. Assessing acceptability of pre-exposure prophylaxis (PrEP) among participants in an HIV vaccine preparedness study in southwestern Uganda. PLoS One 2022; 17:e0271104. [PMID: 35905052 PMCID: PMC9337655 DOI: 10.1371/journal.pone.0271104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Daily oral pre-exposure prophylaxis (PrEP) use is highly effective against HIV infection. However, the uptake of PrEP among individuals at high-risk of HIV acquisition in sub-Saharan Africa varies because of availability and acceptability. We assessed the acceptability of PrEP among participants in a prospective HIV vaccine preparedness study in Masaka, southwestern Uganda. METHODS From November 2018 to August 2019, 20 participants (10 female) were purposively selected for in-depth interviews (IDIs) at 3 and 9 months' post-enrolment in the vaccine preparedness study. Four focus group discussions (FGD) (two among men) were conducted with 29 individuals categorized as: younger (18-24 years) men, younger (18-24 years) women, older (≥30 years) men, and older (≥30 years) women. Apart from IDI specific questions on recent life history including work experience, relationship history and places lived, topics for IDIs and FGDs included knowledge of HIV, perceptions of HIV risk (including own risk), knowledge of and use of PrEP. The Theoretical Framework of Acceptability was used to structure a thematic framework approach for data analysis. RESULTS Participants understood that PrEP was an oral pill taken daily by HIV negative individuals to prevent acquisition of HIV. Overall, interest in and acceptability of PrEP was high, more than half expressed positivity towards PrEP but were not ready to initiate taking it citing the burden of daily oral pill taking, related side effects, stigma and distrust of PrEP. Fourteen participants (from IDI and FGD) initiated PrEP, although some (one FGD and two IDI participants) stopped taking it due to side effects or perceived reduced risk. CONCLUSION We observed a keen interest in PrEP initiation among our study participants. However, a limited understanding of PrEP and associated concerns impeded uptake and sustained use. Hence, interventions are needed to address end-user challenges to increase uptake and support adherence.
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Affiliation(s)
- Sarah Nakamanya
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
- * E-mail:
| | - Rachel Kawuma
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Denis Kibuuka
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Sylvia Kusemererwa
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
| | | | - Eugene Ruzagira
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Kawuma R, Ssemata AS, Bernays S, Seeley J. Women at high risk of HIV-infection in Kampala, Uganda, and their candidacy for PrEP. SSM Popul Health 2021; 13:100746. [PMID: 33604448 PMCID: PMC7873676 DOI: 10.1016/j.ssmph.2021.100746] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/26/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP), antiretroviral medication for prevention of HIV-acquisition, is part of biomedical HIV prevention strategies recommended for people at risk of HIV-infection. A decision to take PrEP depends on an assessment of 'being at risk' either by an individual, or healthcare provider. In this paper, we draw on the concept of 'candidacy' to examine the different ways in which women attending a dedicated clinic in Kampala, Uganda, for women at risk of HIV infection (including sex workers), assessed their suitability for PrEP. We conducted in-depth interviews with 30 HIV negative women up to four different times, to gather information on the motives for taking PrEP, and their life history and daily life. All the women described the relevance of PrEP to mitigate their risk of HIV infection. However, there were challenges to adherence because of alcohol use, irregular working hours and a fear of being seen taking pills that others might assume to be HIV treatment. The ways in which the different women used PrEP and interpreted the place of PrEP in their lives were not solely based on their assessment of protecting themselves during sex work. They also used PrEP to guard against infection from their regular partners, and as a tool to allow them to make more money safely, by having sex without a condom with clients. While eligibility to access PrEP was predicated on the women's being in an 'at risk' population group, an incentive to use PrEP was to protect themselves from HIV acquisition from a long-term partner and preserve the 'trust' in their intimate relationship by having condom-less sex. Applying a candidacy lens we highlight the complexity in how women experience and present as being 'at risk' and query the criteria on which categories of risk and PrEP eligibility are determined.
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Affiliation(s)
- Rachel Kawuma
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | - Sarah Bernays
- School of Public Health, University of Sydney, Sydney, Australia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- School of Public Health, University of Sydney, Sydney, Australia
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