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Background: Despite evidence that pre-exposure prophylaxis (PrEP) effectively prevents HIV among persons who inject drugs (PWID), little research has focused on the willingness of, and potential barriers to PrEP among this population in the US. We sought to determine the proportion of PWID meeting PrEP eligibility criteria and to assess attitudes and barriers to PrEP.
Methods: Participants were English-speaking PWID age ≥ 18 years recruited from a syringe exchange program (SEP). Participants self-obtained specimens for STI screening and completed a survey assessing factors hypothesized to impact PrEP uptake. To determine PrEP eligibility, we used a composite score of based on current CDC clinical guidelines for PrEP. Data was analyzed using descriptive statistics and contingency tables.
Results: Of 138 sequentially enrolled participants, 47% were female, 80% white with median age of 31. Potential barriers to PrEP uptake were common, including PrEP-related embarrassment 45%, anxiety 51.6%, not wanting to disclose PrEP use to a romantic partner 51.4%, lack of engagement with providers were PrEP may be offered 52.9%, and drug dependence 88.4%. Women were statistically more likely to report willingness to take PrEP than men (88.9% v 71.0%; p<0.02); to endorse tolerating mild side effects of PrEP (80.5% vs 60.0%; p<0.03); to find ongoing medical monitoring acceptable (95.9% vs 82.5%; p<0.03); to have current STI (23.3% vs 8.2%; p<0.01); and screen eligible for PrEP (86.2% vs 51.0%; p<0.02).
Conclusions: The majority of participants were eligible for PrEP and found also found the concept acceptable. However, they face multiple barriers to uptake including limited engagement with providers where PrEP care may be offered. Co-locating PrEP with SEPs could reach PWID meeting “highest risk” criteria and decrease barriers to care. Further, targeted efforts for women may be warranted because they were 4-fold more likely to screen for STI, a biomarker for increased HIV risk.