WOMEN’S DECISION-MAKING AROUND PRE-EXPOSURE PROPHYLAXIS FOR HIV PREVENTION
MAY 20, 2020
12:30 P.M. – 2:00 P.M. EDT
ABOUT THE WEBINAR
Oral pre-exposure prophylaxis (PrEP, also called Truvada®) is a highly effective HIV prevention method approved by the FDA in 2012, but its uptake has been limited. Most PrEP advocacy efforts target men who have sex with men because that population contributes the majority of new HIV infections. However, a significant proportion of those at high risk for HIV in the U.S. and potentially eligible for PrEP are women aged 18-59; 25 percent of new HIV infections in NYC are in heterosexual women of color. Gender and racial disparities in PrEP access and uptake are substantial: PrEP prescriptions for women compared to men are declining, and Black women are four times less likely than White women to have initiated PrEP. Understanding why women of color are underrepresented as PrEP users is critical to addressing disparities.
This talk will summarize research findings from an intensive qualitative study of 30 women aged 18-45 years who were being seen for health care at a large urban OB-GYN practice in the Bronx. Those interviewed were asked whether any provider had talked with them about ways to prevent HIV, whether they think they are at risk for HIV and why, if they had prior knowledge and awareness of PrEP, whether they would be receptive to hearing about PrEP from their OB-GYN provider, and if they had any concerns about PrEP. Women completed a PrEP “screen,” which is a checklist to identify whether they would benefit from PrEP based on sexual practices; 21 of 30 women screened positive yet only 8 of these women considered that they were at risk for HIV based on the interview. Of the 9 women at low risk, 7 accurately perceived their risk as low. Most women (n=57 percent) were aware of PrEP, but they believed it was for men who have sex with men. Few (n=3) were willing to take PrEP now, but 64 percent were very receptive to using it in the future should they be at risk. A substantial number (n=7, 24 percent) were not willing to consider PrEP use at all; 6 were under age 30. In their decision-making about whether they would take PrEP, almost all prioritized relationship factors, specifically they perceived that their partner posed no HIV risk. Their confidence in their partner’s monogamy ranged from certain (e.g., they had evidence of a recent HIV negative test) to blind faith, to acknowledged complacency over time, to guarded (“hopefully he’s not cheating on me”). Concerns about adherence to a daily pill or possible side effects of PrEP were low.
Join us for this presentation on how women perceive risk for HIV and decline PrEP for HIV prevention because of its meaning for their relationship. Despite PrEP being touted as a woman-controlled HIV prevention method, women may resist its use if it challenges their trust in their partner or vice versa. By understanding the importance of relationship factors in PrEP decision making, we can do a better job of counseling women about ways to reduce their HIV risk.