Though biomedical HIV prevention measures including post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) are now available, U.S. women’s knowledge, attitudes, and behavior (KAB) about PEP, PrEP and TasP are limited. We sought to identify important barriers and disparities to women’s access.
A nested cross sectional survey among 2406 participants (1690 HIV+ and 716 HIV-) in the Women’s Interagency HIV Study (WIHS) assessed PEP, PrEP and TasP KAB. Data collected in 2014-2015 included questions about HIV testing and risk perception, sexual partners, current medication adherence, PEP, PrEP and TasP awareness and experience, stigma, and prevention beliefs. We used logistic regression to assess factors associated with willingness to use PEP, PrEP or TasP, respectively, and only included those variables statistically significant in univariate analyses into multivariate models.
Mean age of the sample was 47 years, and the majority (72%) were Black. Only 20% of women had heard of PEP and 14% had heard of PrEP. In multivariate analyses, HIV(-) women who would recommend PEP to others (Odds Ratio (OR): 20; 95% confidence interval (CI): 11-37; P < 0.0001) or thought they were at higher risk of HIV infection (OR: 2.2; 95% CI: 1.2-4.2; P = 0.015), were more willing to take PEP. Whereas older women (OR:0.95; 95%CI: 0.92-0.98; P = 0.001) and Black women (OR: 0.34; 95% CI: 0.12-0.96; P = 0.042) were less willing to use PrEP, women with casual sexual partners (OR:0.36; 95% CI:0.14-0.91; P = 0.030), those who believed PrEP will prevent HIV (OR:7.28; 95% CI: 1.92-27.68; P = 0.004), and those willing to recommend PrEP to others (OR; 95%CI; P<0.001) reported willingness to take PrEP themselves. No women in the sample were on PrEP at the time of the study. Interest in learning more about TasP was independently associated with willingness to take PEP/PrEP to prevent transmission to others (OR: 3.09; 95% CI: 1.1-8.7; P = 0.033) among HIV+ women.
Knowledge and use of PEP/PrEP was limited among women in the study. Many factors may affect use of PEP, PrEP and TasP among women. Reporting higher risk was associated with willingness to use these biomedical prevention modalities. Further studies are needed to identify modifiable factors to improve uptake of biomedical interventions for high risk women.