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.

ABOUT THE SPEAKERS

Laurie J. Bauman, Ph.D.
Professor
Albert Einstein College of Medicine

Dr. Laurie Bauman is Tenured Professor of Pediatrics and of Psychiatry and Behavioral Science at the Albert Einstein College of Medicine. She is Director of the Preventive Intervention Research Center, and leads two scientific cores, the BioBehavioral Core of the HIV Center for Clinical and Behavioral Research at Columbia University and the Behavioral Science Core of the Einstein-Rockefeller-CUNY Center for AIDS Research. Her work focuses on HIV prevention in adolescents and ways to scale up Pre-Exposure Prophylaxis (PrEP) in medical care settings.

Siobhan M. Dolan, M.D., M.P.H.
Professor and Vice Chair, Obstetrics & Gynecology and Women’s Health
Albert Einstein College of Medicine

Dr. Siobhan Dolan is Professor and Vice Chair for Research in the Department of Obstetrics & Gynecology and Women’s Health at Albert Einstein College of Medicine and Montefiore Medical Center in the Bronx. Board-certified in both OB/GYN and Clinical Genetics, she maintains her clinical practice in the Division of Reproductive and Medical Genetics at Montefiore where she works to improve the health of mothers and children by preventing birth defects, preterm birth, and infant mortality.

ABOUT THE MODERATOR

Tamara Lewis Johnson, M.P.H., M.B.A.
Chief, Women’s Health Research Program
Office for Disparities Research and Workforce Diversity, National Institute of Mental Health

Ms. Tamara Lewis Johnson is the Chief of the Women’s Health Research Program for the Office for Disparities Research and Workforce Diversity. She is responsible for providing advice and guidance on matters relating to women’s health research and mental health. Ms. Lewis Johnson brings 11 years of experience in health science management from the National Institute of Allergy and Infectious Diseases (NIAID) where she served as a Health Science Specialist in the Division of Extramural Activities’ Office of Extramural Research Policy Operations. Ms. Lewis Johnson supported the development of initiatives to promote investments in biomedical research that advance public health outcomes. She has produced reports that describe the importance of infectious and immune-mediated research initiatives to congressional staffers, scientific organizations, and constituency groups. Her expertise in systems engineering, implementation science and operations research have enabled her to advance translational research that can be used in low-income settings in the United States and abroad. Ms. Lewis Johnson has been instrumental in the development of scientific workgroups to advance public health outcomes through the support of discovery science to advance improved diagnostics, drug development, and vaccine research. She also served as the Senior Program Manager for Women’s Health for the Office of Special Populations and Research Training where she was responsible for managing research and training initiatives related to women’s health research in infectious diseases and immune-mediated illnesses.

Prior to her work at NIAID, Ms. Lewis Johnson worked at the Health Resources and Services Administration (HRSA) as the Women’s Health Team Lead and Acting Deputy Director of the Office of Women and Minority’s Health (OWMH), at HRSA’s Bureau of Primary Health Care (BPHC). Ms. Johnson holds two Master’s degrees, one in Business Administration and one in Public Health, with a concentration in Health Services Management, from the University of California, Berkeley, as well as a Bachelor’s degree in Industrial Engineering from Stanford University.