“I’ve been 95% safe”: perspectives on HIV pre-exposure prophylaxis at a drug detoxification center: a qualitative study

ABSTRACT

Pre-exposure prophylaxis (PrEP) decreases human immunodeficiency virus (HIV) acquisition among persons who inject drugs (PWID); however, its uptake has been suboptimal. We explored HIV risk perceptions and PrEP interest among drug detoxification center patients in the context of the ongoing opioid overdose epidemic. We conducted in-depth interviews of patients (n = 24) and professional key informants (n = 10 physicians, case managers, nurses, and harm reduction educators), and thematic analysis of coded data. The mean age of participants (patients) was 37 years; 54% identified as male and 67% as White. Although 71% reported injecting drugs and 62% had condomless sex in the past 6 months, participants had mixed HIV risk perceptions, and some viewed PrEP as an undesirable indicator of elevated HIV risk. Nevertheless, many participants viewed drug detoxification as a first step towards embarking on a “healthier lifestyle,” with some narratives identifying opportunities for delivering PrEP information and services in this setting. Opportunities exist to expand PrEP at drug detoxification centers, but initiatives are needed to educate patients and staff on indications and benefits of this prevention tool. Interventions are also needed to determine the best strategies for implementing PrEP adoption in this setting.

KEYWORDS:

• Human immunodeficiency virus
• pre-exposure prophylaxis
• persons who inject drugs
• drug detoxification center

Acknowledgements

The authors would like to thank study participants and our research team for their contributions to this work. Special thanks to Imaan Umar for assistance in reviewing the transcripts. The content is solely the responsibility of the authors and does not necessarily represent the official views of National Institutes of Health.

Disclosure statement

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

Additional information

Funding

This work was supported by the National Institute of Drug Abuse [K23DA044085 and K23 DA044085-03S1 to S.A.A, and K01DA043412 to A.R.B] and a Boston University School of Medicine Department of Medicine Career Investment and Evans Junior Faculty Research Merit Awards to SAA