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Background: HIV pre-exposure prophylaxis (PrEP) has emerged as an important tool in the prevention of HIV globally. As we implement PrEP, it is critical to understand perceptions among key target populations, including populations in and from areas with the highest prevalence of HIV such as Africa and the Caribbean. We seek to determine perceptions of PrEP among African and Caribbean immigrants in Philadelphia.
Methods: The African Diaspora Health Initiative is a community-based participatory HIV screening program in Philadelphia. African and Caribbean immigrants in community settings such as churches and mosques are screened for HIV in a series of Clinics Without Walls. An anonymous survey is administered to each participant. Included in this survey are questions about demographics, risk behaviors, HIV risk perception, acceptance of PrEP, and reasons for acceptance or refusal. Correlates of acceptance were determined by SAS 9.2 (Cary, NC).
Results: Between July 2012 and May 2013, 1,324 individuals participated in HIV screening and completed the survey in 56 Clinics Without Walls. Approximately half of participants (49%) were female, and 56% were African. Median length of time in the US was 9 years. The overall acceptance rate of PrEP was 38.2%. Acceptance was lowest among Caribbean women (20.4%), and highest for African men (46.1%). Correlates of acceptance included intermittent condom use, same sex activity, having a partner in one’s home country, and high HIV risk perception. The main reason for acceptance was fear of HIV, and for rejection was the lack of recognition of risk.
Conclusions: Among Philadelphia’s African and Caribbean immigrants, acceptance rates of PrEP are low, differing by gender and by world region of origin. Addressing reasons for rejection is essential for successful implementation of PrEP in this community. Further study is necessary to determine the impact of perceptions of PrEP on reported and actual adherence.