HIV Pre-Exposure Prophylaxis Prevention Awareness, Willingness, and Perceived Barriers among People Who Inject Drugs in Los Angeles and San Francisco, CA, 2016–2018

Abstract

Background

Pre-exposure prophylaxis (PrEP) for HIV prevention is indicated for people who inject drugs (PWID), yet most studies do not focus on PWID. This study examines factors associated with PrEP awareness and willingness, and identifies perceived barriers to PrEP among PWID. Methods: PWID were interviewed in Los Angeles and San Francisco, CA from 2016 to 2018. We analyzed data from self-reported HIV-negative participants who had injected drugs within the past 6 months (n = 469). Questions on PrEP included awareness, willingness, barriers, and uptake. Multiple logistic regression models of factors associated with awareness of, and willingness to, take PrEP were developed. Descriptive statistics on perceived PrEP barriers are reported. Results: Among HIV-negative PWID, 40% were aware of PrEP, 59% reported willingness to take PrEP, and 2% were currently taking PrEP. In multivariable analysis, PrEP awareness was associated with study site and sexual minority status, higher educational attainment, and HIV testing in the last 6 months. Willingness to take PrEP was associated with self-reported risk (paying sex partner in the last 6 months, sharing drug paraphernalia, and being injected by another PWID) and perceived HIV risk. The most common perceived barriers to PrEP were copays, concerns about increased HIV or sexually transmitted risk with PrEP, and concerns about reduction of medication efficacy without daily use. Conclusion: PrEP awareness among PWID remains inadequate. Willingness to take PrEP was moderate and was most desired by PWID who engaged in high-risk behaviors. Interventions to increase PrEP awareness and willingness, and to facilitate PrEP uptake among PWID are needed.

Keywords:

• Pre-exposure prophylaxis
• persons who inject drugs

Acknowledgments

We would like to thank study participants for their time and effort in this project. We would also that the following individuals who meaningfully contributed to the study: Amin Afsahrezvani, Debra Allen, Letizia Alvarez, Julia Balboni, Joseph Becerra, Kacie Blackman, Guiseppe Cavaleri, Janae Chatmon, Fitsum Dejene, Karina Dominguez Gonzalez, Mohammed El-Farro, Brian Erwin, Sernah Essien, Allison Few, Hrant Gevorgian, Allessandra Gianino, Johnathan Hakakha, Jennifer Hernandez, Monika Howe, Alexander Ildaradashty, Cora Jenkins, Sasha Lasky, Joshua McKeever, Askia Mohammad, Rebecca Penn, Tasha Perdue, Jennifer Plumber, T’yana Taylor, Olivia Uhley, Jeffery Williams, David Wiss, Thomas Won, Senem Yilmaz, and Johnathan Zhao.

Declaration of interest

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the article.

Data statement

Data will be made available to other investigators 1 year following the completion of this study (July 2020).

Additional information

Funding

This work was funded by the National Institute on Drug Abuse (NIDA) [grant numbers RO1 DA038965, Project Official, Richard Jenkins, Ph.D.; T32 DA007233-31, PI: Falkin; and R25DA026401; PI Avelardo Valdez].