Among women in the United States, non-Latina black women in the South have disproportionately high rates of new HIV infections but low use of pre-exposure prophylaxis (PrEP). Effective strategies to identify factors associated with PrEP eligibility could facilitate improved screening, offering, and uptake of PrEP among US women at risk of HIV.
We applied 2014 CDC criteria for PrEP use to at-risk HIV-negative women enrolled in the Southern US sites (Atlanta, Chapel Hill, Birmingham/Jackson, Miami) of the Women's Interagency HIV Study from 2014 to 2015 to estimate PrEP eligibility and assess PrEP knowledge and acceptability. Factors associated with PrEP eligibility were assessed using multivariable models.
Among 225 women, 72 (32%) were PrEP-eligible; the most common PrEP indicator was condomless sex. The majority of PrEP-eligible women (88%) reported willingness to consider PrEP. Only 24 (11%) PrEP-eligible women had previously heard of PrEP, and only 1 reported previous use. Education level less than high school [adjusted odds ratio (aOR) 2.56; 95% confidence interval (CI): 1.22 to 5.37], history of sexual violence (aOR 4.52; 95% CI: 1.52 to 17.76), and medium to high self-perception of HIV risk (aOR 6.76; 95% CI: 3.26 to 14.05) were significantly associated with PrEP eligibility in adjusted models.
Extremely low PrEP awareness and use despite a high proportion of eligibility and acceptability signify a critical need to enhance PrEP education and delivery for women in this region. Supplementing CDC eligibility criteria with questions about history of sexual violence and HIV risk self-assessment may enhance PrEP screening and uptake among US women.
aEmory University, Atlanta, GA;
bGeorgetown University Medical Center, Washington, DC;
cMontefiore Medical Center, Albert Einstein College of Medicine, New York, NY;
dUniversity of California San Francisco, San Francisco, CA;
eUniversity of Alabama at Birmingham, Birmingham, AL;
fUniversity of Miami Miller School of Medicine, Miami, FL;
gJohns Hopkins Bloomberg School of Public Health, Baltimore, MD;
hUniversity of North Carolina at Chapel Hill, Chapel Hill, NC;
iRuth M. Rothstein CORE Center, Stroger Hospital of Cook County, Chicago, IL;
jSUNY Downstate Medical Center, Brooklyn, NY; and
kColumbia University Mailman School of Public Health, New York, NY.
Correspondence to: Anandi N. Sheth, MD, MS, Division of Infectious Diseases, Department of Medicine, Emory University, 49 Jesse Hill Jr Drive, Atlanta, GA 30303 (e-mail: firstname.lastname@example.org).
Supported by the National Center for Advancing Translational Sciences of the National Institutes of Health award number TL1 TR002382 (PI: Dr. Henry M. Blumberg), the National Institute of Allergy and Infectious Diseases award number 5U01AI103408 (PI Dr. I.O.), and the National Institute of Allergy and Immunology award number 1K23AI114407 (PI: Dr. A.N.S.).
Presented in part at Conference on Retroviruses and Opportunistic Infections (CROI 2018); March 4–7, 2018; Boston, MA, Abstract 1048.
The authors have no funding or conflicts of interest to disclose.
Received September 10, 2018
Accepted November 28, 2018