Racial and ethnic differences in women’s HIV risk and attitudes towards pre-exposure prophylaxis (PrEP) in the context of the substance use, violence, and depression syndemic

ABSTRACT

Women with syndemic conditions, i.e., two or more co-occurring epidemics, are at elevated risk for HIV acquisition and are therefore prime candidates for pre-exposure prophylaxis (PrEP). However, PrEP uptake remains low among women, especially among Black and Hispanic women. This study examined associations of syndemic conditions with PrEP attitudes and HIV risk among women, and the moderating effect of race and ethnicity. In 2017, 271 non-Hispanic Black, non-Hispanic White, and Hispanic, PrEP-eligible women engaged in care at Planned Parenthood in the northeastern region of the U.S. completed an online survey. Participants reported syndemic conditions (i.e., intimate partner violence, depression, substance use), PrEP attitudes (e.g., PrEP interest), HIV sexual risk (e.g., multiple male sexual partners), and sociodemographics. Structural equation modeling was used to examine the effects of syndemic conditions on PrEP attitudes and HIV risk, and the moderating effect of race and ethnicity. Women with more syndemic conditions had a higher odds of reporting multiple male sexual partners. Syndemic conditions were positively associated with PrEP attitudes for Hispanic women than non-Hispanic Black and White women. Women with syndemic conditions, particularly Hispanic women, may be receptive to interventions promoting PrEP.

Acknowledgements

The authors wish to thank the Connecticut Planned Parenthood patients who generously contributed their time and effort by participating in this study. We are grateful to Ms. Susan Lane, Director of Planning and Grants at Planned Parenthood of Southern New England, Inc., for her help with data collection and other facets of the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Yale University Center for Interdisciplinary Research on AIDS and the National Institute of Mental Health (NIMH) [grant number P30-MH062294]. TCW was supported by the NIMH [grant numbers F31-MH113508 and R25-MH083620]. Support for SKC was provided by the NIMH [grant number K01-MH103080]. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH). The findings and conclusions in this article are those of the authors and do not necessarily reflect the views of Planned Parenthood Federation of America, Inc. DO was employed at GWU and the content does not represent the views of the National Center for Health Statistics, Centers for Disease Control and Prevention.