Correlates of PrEP Awareness Among High Risk Heterosexual Women

Background

In the United States (US), black women accounted for 61% of new infections among all women. In comparison to other racial groups, black women’s HIV incidence rate is 25 times higher than the rate for white women. Oral daily pre-exposure prophylaxis, (PrEP) is a single tablet that is more than 90% effective in reducing HIV transmission among women, men who have sex with men and serodiscordant couples. PrEP is an efficacious, self-administered, woman-controlled HIV prevention option that has been considered acceptable among black women. Despite evidence of PrEP’s efficacy and safety for women, awareness, prescription, and uptake of PrEP as Truvada an HIV prevention option among black women is disproportionately low. Studies suggest lack of knowledge and dissemination of PrEP information is a barrier to PrEP uptake among black women. To address this gap, this study sought to identify factors associated with PrEP awareness in a sample of high-risk heterosexual women.

Methods

Data were drawn from the Centers for Disease Control and Prevention’s 2016 National HIV Behavioral Surveillance Survey, heterosexual cycle. Eligible participants were individuals self-identifying as women living in Wayne County, Michigan and who had sex with a person of the opposite sex in the 12 months preceding the interview.  Respondents in this sample was restricted to women who were HIV negative during the interview. Analysis involved univariate, bivariate, and multivariate statistics including demographic variables such as age, employment status, health insurance status, poverty status, and education.  Sexual risk variables included perceived HIV risk, HIV testing in the past 12 months, STD testing in the past 12 months, and the dependent variable included; have you ever heard of PrEP taken daily to reduce risk of HIV (yes/no).

Results

PrEP awareness in the sample of high risk women (N=520), was very low, (n=50, 10.4%). Demographic characteristics of the sample included predominately Black respondents (96%), the mean age was 41 years of age, most were single/unmarried (93%), unemployed (65.8%), and of poverty status (77%).  Prevention behaviors in the population, 49% had received an HIV test in the past 12 months of which 12% were aware of PrEP, STD in the past year was slightly less common 35.1% of which 10.1% heard of PrEP, and 67.3% of respondents perceived they were at low or no risk of acquiring HIV of which 9.3% were aware of PrEP.  Nothing was associated at the bivariate and multivariate level with PrEP awareness. 

Conclusions/Implications:

Dissemination of PrEP among black women face several known challenges some of which are more prevalent in race and gender minority communities including; HIV stigma, social acceptability, partner attitudes and perceived risk. These challenges require in-depth understanding of the social and cultural mechanisms of influence that impact the dissemination process. The low PrEP awareness, particularly in a high-risk sample is a problematic trend in HIV research. This limits our examination of PrEP acceptability, uptake, and adherence among Black women. Further research should examine the barriers and facilitators to the diffusion of PrEP information to high risk Black women.