Awareness of pre-exposure prophylaxis (PrEP) among women who inject drugs in NYC: the importance of networks and syringe exchange programs for HIV prevention

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Abstract

Background

Women who inject drugs (WWID) are at heightened risk for HIV due to biological, behavioral, and structural factors. Pre-exposure prophylaxis (PrEP) could aid in HIV prevention for WWID. However, little is known about WWID awareness of PrEP, which is a necessary step that must occur before PrEP uptake. We report factors associated with greater awareness among WWID to identify efficient means of awareness dissemination.

Methods

Data from the 2015 National HIV Behavioral Surveillance (NHBS) system cycle on injection drug use collected in New York City (NYC) were used. Bivariable analyses, using chi-squared statistics, were conducted to examine correlates of awareness of PrEP with socio-demographic, behavioral, and health care variables. Multivariable logistic regression was used to estimate adjusted associations and determine differences in awareness of PrEP.

Results

The analysis consisted of 118 WWID. Awareness of PrEP was relatively low (31%), and risk factors were high. In the last 12 months, almost two thirds (65%) reported condomless sex, approximately one third (31%) reported transactional sex, and one third (32%) reported sharing injection equipment. In multivariable logistic regression, increased PrEP awareness was associated with reported transactional sex (AOR 3.32, 95% CI 1.22–9.00) and having a conversation about HIV prevention at a syringe exchange program (SEP) (AOR 7.61, 95% CI 2.65–21.84). We did not find race, education, household income, age, binge drinking, or sexual identity to be significantly associated with PrEP awareness.

Conclusions

Large proportions of WWID were unaware of PrEP. These findings suggest that social networks (specifically sex work and SEP networks) are an efficient means for disseminating messaging about prevention materials such as PrEP. We recommend that SEP access increase, SEP processes be adopted in other health care settings, and WWID networks be utilized to increase PrEP awareness.

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Most cited references 77

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There is increasing appreciation of the need to understand how social and structural factors shape HIV risk. Drawing on a review of recently published literature, we seek to describe the social structural production of HIV risk associated with injecting drug use. We adopt an inclusive definition of the HIV 'risk environment' as the space, whether social or physical, in which a variety of factors exogenous to the individual interact to increase vulnerability to HIV. We identify the following factors as critical in the social structural production of HIV risk associated with drug injecting: cross-border trade and transport links; population movement and mixing; urban or neighbourhood deprivation and disadvantage; specific injecting environments (including shooting galleries and prisons); the role of peer groups and social networks; the relevance of 'social capital' at the level of networks, communities and neighbourhoods; the role of macro-social change and political or economic transition; political, social and economic inequities in relation to ethnicity, gender and sexuality; the role of social stigma and discrimination in reproducing inequity and vulnerability; the role of policies, laws and policing; and the role of complex emergencies such as armed conflict and natural disasters. We argue that the HIV risk environment is a product of interplay in which social and structural factors intermingle but where political-economic factors may play a predominant role. We therefore emphasise that much of the most needed 'structural HIV prevention' is unavoidably political in that it calls for community actions and structural changes within a broad framework concerned to alleviate inequity in health, welfare and human rights.

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Stigma, discrimination and the health of illicit drug users.

Jennifer Ahern, Jennifer Stuber, Sandro Galea (2007)

Persons who use illicit drugs are stigmatized in the United States. The conferral of a deviant social status on illicit drug users may serve to discourage use. However, stigmatization may also adversely affect the health of those who use illicit drugs, through exposure to chronic stress such as discrimination and as a barrier to accessing care. We hypothesized that aspects of stigma and discrimination would be associated with mental and physical health among illicit drug users. Using street outreach techniques, 1008 illicit drug users were interviewed about stigma and discrimination related to their drug use, and their health. We measured discrimination related to drug use, alienation, perceived devaluation, and responses to discrimination and stigma. Health measures included mental and physical health measures from the Medical Outcomes Study Short Form-36, depression symptoms from the Center for Epidemiological Studies Depression scale, and a sum of health conditions. In adjusted models, discrimination and alienation were both associated with poorer mental health, and only discrimination was associated with poorer physical health. Angry responses to discrimination and stigma were associated with poorer mental health. The association of stigma and discrimination with poor health among drug users suggests the need for debate on the relative risks and benefits of stigma and discrimination in this context.

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Author and article information

Contributors

Suzan M. Walters: (631) 632-7739 , suzanmwalters@gmail.com

Journal

Journal ID (nlm-ta): Harm Reduct J

Journal ID (iso-abbrev): Harm Reduct J

Title: Harm Reduction Journal

Publisher: BioMed Central (London )

ISSN (Electronic): 1477-7517

Publication date (Electronic): 29 June 2017

Publication date PMC-release: 29 June 2017

Publication date Collection: 2017

Volume: 14

Electronic Location Identifier: 40

Affiliations

[1 ]ISNI 0000 0001 2216 9681, GRID grid.36425.36, Department of Sociology, , State University of New York at Stony Brook, ; Stony Brook, NY USA

[2 ]ISNI 0000 0001 0320 6731, GRID grid.238477.d, , New York City Department of Health and Mental Hygiene, ; New York City, NY USA

[3 ]ISNI 0000000419368729, GRID grid.21729.3f, Department of Epidemiology Joseph L. Mailman School of Public Health, , Columbia University, ; New York, NY USA

[4 ]Stony Brook, New York, NY 11794-4356 USA

Article

Publisher ID: 166

DOI: 10.1186/s12954-017-0166-x

PMC ID: 5492910

PubMed ID: 28662716

SO-VID: fbf7df3e-01b1-45cf-85b2-06432a7b4bed

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 12 April 2017

Date accepted : 5 June 2017

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: hiv,pre-exposure prophylaxis,sex work,syringe exchange programs,gender,injection drug use

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: hiv, pre-exposure prophylaxis, sex work, syringe exchange programs, gender, injection drug use

Awareness of pre-exposure prophylaxis (PrEP) among women who inject drugs in NYC: the importance of networks and syringe exchange programs for HIV prevention

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Tobacco Prevention & Cessation

Most cited references 77

Doctor-patient communication: a review of the literature.

The social structural production of HIV risk among injecting drug users.

Stigma, discrimination and the health of illicit drug users.

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