PrEP and HIV prevention decision-making among social network members of women who have experienced incarceration: a qualitative study

ABSTRACT

Incarceration and HIV are a syndemic for US women, yet very few women who have experienced incarceration use pre-exposure prophylaxis (PrEP) for HIV. We conducted semi-structured interviews with 32 participants recruited by women who have experienced incarceration from their social networks, informed by the modified social ecological model for PrEP. Emergent themes from the interviews included individual-level (low personal HIV risk assessment, personal responsibility for HIV prevention, and decisions in addiction versus recovery), network-level (influential sex partners and the importance of trust, supportive treatment peers, and high-risk but indifferent drug use networks), community-level (stigma, and mitigation of stigma in supportive substance use disorder treatment environments), and public policy-level (incarceration and PrEP cost and access) determinants. PrEP interventions for women who have experienced incarceration and their networks will need to incorporate contingency planning into HIV risk assessment, navigate complex network dynamics, and be situated in trusted contexts to address structural barriers.

KEYWORDS:

• Pre-exposure prophylaxis
• women
• incarceration

Acknowledgements

The authors would like to thank all of the participants and CBO staff, without whom this study would have been impossible. In addition, they would like to acknowledge Drs. Hendree Jones, Kim Andringa, and Jim Moody for their formative feedback on the study design.

Disclosure statement

Dr. Adimora has received consulting fees from Merck, Viiv, and Gilead, and UNC has received funds from Gilead for the research. The other authors report no conflicts of interest.

Additional information

Funding

This project was supported by joint pilot funding from the UNC Center for Health Equity Research and the Integrating Special Populations program within the UNC Clinical and Translational Science Award program of the National Center for Advancing Translational Sciences, National Institutes of Health (UL1TR002489). Dr. Knittel is a faculty scholar in the UNC WRHR Career Development Program which is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12 HD103085).