Barriers to accessing pre-exposure prophylaxis among women experiencing intimate partner violence in the United States: a systematic literature review

ABSTRACT

Women experiencing intimate partner violence (IPV) are at increased risk of human immunodeficiency virus (HIV) infection but have limited uptake of pre-exposure prophylaxis (PrEP). We systematically reviewed the existing evidence for the association between IPV and PrEP use, and barriers to accessing PrEP among women with a history of IPV in the United States. A keyword search of PubMed, CINAHL, ScienceDirect, and Web of Science for relevant articles within the United States from 2012 to 2022 yielded 133 articles, of which 15 were ultimately included in the analysis. A qualitative synthesis of evidence suggests that the association between IPV and PrEP awareness, PrEP acceptability, PrEP use, and HIV risk perception was contingent on the mediating or moderating effects of women’s relationship status, social network characteristics, and the timing and types of IPV. Controlling partners’ reactions and a lack of independent decision-making in the abusive relationship were salient barriers. The methodological quality of qualitative studies was high; however, there were important risks of bias among quantitative and mixed-method studies. Additional studies are needed to understand barriers to PrEP use among women with IPV in more diverse settings and to provide rigorous evidence for developing targeted HIV prevention strategies for them.

KEYWORDS:

• HIV
• pre-exposure prophylaxis
• intimate partner violence
• women
• systematic review

Acknowledgments

The authors are grateful to Sue Kaczor for consultation on database selection and key word search terms. We also sincerely thank Ashley Fox and Lucy Sorensen for helpful comments on an earlier draft.

Disclosure statement

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

Data availability statement

This is a systematic literature review and there is no dataset associated with this article.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.