Perceptions of HIV Pre-Exposure Prophylaxis in a High-Risk Population in Urban United States

Background:  HIV pre-exposure prophylaxis (PrEP) has been studied in populations around the globe, including US communities.  As we implement PrEP in the US, it is important that we understand how PrEP is perceived.  We seek to determine perceptions of PrEP in a high-risk population undergoing HIV testing in an urban community center setting.  The objective determination of risk estimate used here has been found in previous study to correlate closely with HIV prevalence.

Methods:  In the health centers operated by the Philadelphia Health Department, individuals in walk-in clinics are offered rapid HIV testing.  For each individual, an anonymous survey is administered.  Included are questions about demographics, risk behavior, risk perception, risk estimate based on reported behaviors, acceptance of PrEP, and reasons for acceptance or refusal.  Data are analyzed using SAS 9.2.

Results:  Between July 2012 and May 2013, 1,973 individuals participated in the study, 1,073 of whom were determined to be at high risk for HIV.  Almost half (47.2%) were women, and a majority (89.2%) were Black non-Hispanic.  The overall acceptance rate of PrEP was 69.2%.  Acceptance rates were higher for men than women (71.5% and 65.1%, p<0.01), and for African Americans compared with non-African Americans (69.2% and 62.1%, p=0.006).  Rates were lower among those with zero perceived risk (50.3% compared with 92.3%, p<0.01).  There was no correlation between acceptance rates and HIV test result, number of partners, condom use or risk estimate.

Conclusions:  Among a largely Black non-Hispanic population in US community health centers at high risk for HIV infection, acceptance rates of PrEP were high.  As we seek to implement PrEP in the US for this important target population, it is critical to make every effort to educate about the availability of PrEP, and to ensure access to it.