Abstract Body


HIV pre-exposure prophylaxis (PrEP) awareness and use among persons who inject drugs (PWID) has been low since the introduction of PrEP in the U.S. in 2012. Limited data are available to monitor PrEP awareness and use specifically among PWID.


In 19 U.S. cities participating in 2018 and 2022 National HIV Behavioral Surveillance, PWID were recruited using respondent-driven sampling and offered a behavioral survey and HIV testing. We examined the prevalence of PrEP awareness and PrEP use in the past 12 months, overall and by key characteristics, among HIV-negative PWID in 2018 and 2022. We obtained adjusted prevalence ratios, 95% confidence intervals, and p-values using log-linked Poisson models accounting for clustering by recruitment chain and adjusting for city and participant network size to assess changes in PrEP outcomes over time.


From 2018 to 2022, PrEP awareness among PWID increased from 25.6% to 35.3% (p<0.01), yet PrEP use in the past year remained stable at 1.2% (p=0.35) (Table). The approximate 10 percentage-point increase in PrEP awareness between 2018 and 2022 was consistent across demographic and behavioral subgroups. PrEP awareness increased significantly among PWID who had receptively shared syringes, shared injection equipment, had condomless vaginal or anal sex, and had a bacterial STI in the past year (all p-values <0.01). Minimal yet significant increases in PrEP use were observed for those who had receptively shared syringes, shared injection equipment, and received a recent HIV test (all p-values <0.05); nevertheless PrEP uptake in these groups did not surpass 2%. PrEP use was highest among those reporting past-year male-male sex and bacterial STI (both 4.8% in 2022); this was stable compared with 2018.


PrEP awareness significantly increased from 2018 to 2022 among PWID. Still, only about one-third were aware of PrEP in 2022. Increases in awareness were consistent across subgroups, suggesting that PrEP messaging is reaching groups with a greater risk of HIV acquisition, yet changes may be due to a generalized increase in awareness overall. PrEP use remained suboptimal. PWID at higher risk of injection-related HIV acquisition and those who obtained HIV-related services did experience significant increases in PrEP uptake unlike other subgroups; however, increases were small. Efforts to improve PrEP messaging, provider training, and access specifically for PWID may serve to further increases in PrEP awareness and use.