Structural vulnerabilities and PrEP awareness among Boston heterosexuals and people who inject drugs at risk for HIV: findings from 2018 to 2019 cycles from the Boston, MA site of the NHBS

ABSTRACT

Little is known about biopsychosocial factors relating to pre-exposure prophylaxis (PrEP) awareness among people with either heterosexual or injection drug use HIV risk behaviors. Participants engaged in vaginal/anal sex with a person of the opposite sex (N = 515) or were people who injected drugs (PWID; N = 451) in the past 12 months from 2018-2019 in Boston, MA. We examined associations between PrEP awareness and: homelessness; perceived HIV-related stigma; country of birth; bacterial STDs, chlamydia, and/or gonorrhea in the past 12 months, lifetime hepatitis C virus (HCV) infection, sexual orientation, and poverty. More PWID (36.8%) were aware of PrEP than people with heterosexual HIV risk (28%; p = .001). Among people with heterosexual risk, homelessness (aOR = 1.99, p = .003), and among PWID: homelessness (aOR = 2.11, p = .032); bacterial STD (aOR = 2.96, p = .012); chlamydia (aOR = 6.14, p = .008); and HCV (aOR = 2.40, p < .001) were associated with increased likelihood of PrEP awareness. In the combined sample: homelessness (aOR = 2.25, p < .001); HCV (aOR = 2.18, p < .001); identifying as homosexual (aOR = 3.71, p = .036); and bisexual (aOR = 1.55, p = .016) were each associated with PrEP awareness. Although having an STD, HCV, identifying as homosexual or bisexual, and experiencing homelessness were associated with increased PrEP awareness, most participants were unaware of PrEP. Efforts to increase PrEP awareness could engage PWID and heterosexual HIV risk behavior.

KEYWORDS:

• Pre-exposure prophylaxis (PrEP)
• PrEP awareness
• people who inject drugs
• sexually transmitted infection
• homelessness

Acknowledgments

The content of this study is the sole responsibility of the authors and does not necessarily represent the views of the funders. Publication of the study results was not contingent on the sponsor’s approval of the manuscript. We would like to thank the participants for their time and information. We would also like to thank the teams of individuals who made this study possible at the Massachusetts Department of Public Health and The Fenway Institute, such as Justin Hinchey, Chris Wittke, and many others. RMK was supported by the Centers for Disease Control and Prevention Cooperative Agreement No. NU62PS005074. JSL’s time on this manuscript was supported by T32MH116140 (Henderson, Fricchione). AWB’s time on this manuscript was supported by K23DA043418. AMS’s time on this manuscript was supported by K23MH131438.

Consent to participate

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

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval

All procedures were approved by the Massachusetts Department of Public Health IRB; CDC classifies NHBS as surveillance and not human subjects research. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

Funding

RMK was supported by the Centers for Disease Control and Prevention Cooperative Agreement No. NU62PS005074. JSL’s time on this manuscript was supported by T32MH116140 (Henderson, Fricchione). AWB’s time on this manuscript was supported by K23DA043418. AMS’s time on this manuscript was supported by K23MH131438. This study was funded by the U.S. Department of Health and Human Services [grant number NU62PS005074]. CO's time was also supported by the Harvard University Center for AIDS Research (CFAR) [grant number P30AI060354].