The emergency response to the 2015 HIV outbreak among persons who inject drugs (PWID) in rural Indiana included increased HIV testing, establishment of a syringe services program (SSP), and HIV care services in this underserved area. We assessed uptake of HIV testing and prevention services among PWID one year after outbreak identification.
PWID in the outbreak area were recruited using respondent-driven sampling between January and February 2016 and interviewed using a structured questionnaire about demographics, HIV testing and diagnosis, and awareness of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for HIV. We report percentages and medians with interquartile ranges (IQR) for categorical and continuous variables respectively. We used Fisher’s exact test to assess differences in PrEP knowledge based on last HIV test location.
Of 200 participants, 58% were male, 92% were non-Hispanic white, and 92% were heterosexual. Median age was 35 years (IQR: 28, 43). Fifty-nine (30%) persons reported being HIV-positive and 81% of them received the diagnosis in the last year. Only 15 (8%) reported never testing for HIV; most common reasons for not testing were perceived low risk of infection, fear of diagnosis, and other reasons; stigma was not cited as a reason for not testing. Of the 185 persons who ever tested for HIV, 52% had not tested before the outbreak but were tested during/after the outbreak response. Of 182 persons reporting the location of their last HIV test, 21% tested at the community outreach center/SSP, 15% at jail/prison, 15% were tested by a professional at home, and the remaining persons reported utilizing 1 of 7 other testing options. Sixty-six (33%) and 21 (11%) participants reported having heard of PrEP or PEP, respectively. Of those who had heard of PrEP, 3 were taking it; no one reported taking PEP. Of those reporting the location of their last HIV test, 53% of those who last tested at the SSP expressed knowledge of PrEP, compared to 32% of those whose last HIV test was not at the SSP (p=0.023).
Enhanced HIV testing efforts following an HIV outbreak among PWID in Indiana were associated with increased HIV testing and diagnoses. Awareness and use of PrEP and PEP were low, but PrEP awareness was significantly higher among those whose last HIV test was at the SSP. These findings indicate a need for increased education and access to PrEP and PEP, and suggest that SSPs may offer a useful forum for PrEP/PEP education.