Black women in Chicago are disproportionately affected by HIV, but few are on PrEP. We report the results of a mixed methods study of knowledge, attitudes, experience, and preferences for PrEP among cis-gender women in Chicago.
We administered a survey to 370 HIV(-) women visiting either a public Sexually Transmitted Infection clinic or an Emergency department and conducted focus groups with 16 PrEP-naive women and in-depth interviews with 7 PrEP-using women. Survey data were analyzed using descriptive statistics and multivariate logistic regression as well as thematic analysis for qualitative data.
Majority of women identified as black (83%) and had a regular source of healthcare (71%). In the last 6 months, 83% had vaginal or anal sex and 93% inconsistent condom. Women had low rates of perceived HIV risk (90% low/no). Only 30% (112) had heard of PrEP before the survey. The only factor associated hearing about PrEP was knowing someone on PrEP (OR 15.6 95%CI (3.0-80.3)). One third (29%(105)) considered starting PrEP in the next 6 months, with protecting health (77%) and reducing HIV worry (58%) most common reasons. Most (81%) had concerns about taking PrEP with side effects (68%)) and incomplete protection (25%) most common;72% would need some form of support. Most preferred source for information and PrEP was their primary care site, with cost (25%), clinic familiarity (23%) and confidentiality (24%) most important. Factors associated with starting PrEP included being Latina (OR 3.5 95%CI (1.2-10.0), recent STI (OR 2.6 95%CI (1.3, 5.0)), more worry about HIV (OR 1.2 95%CI (1.0-1.5)) and higher belief in PrEP effectiveness (OR 2.1 95%CI (1.4, 3.3)). Qualitative themes aligned with survey results including the lack of PrEP knowledge, viewing PrEP as beneficial, and importance of trusted health providers. FGs also found disconnection with current PrEP advertisements, need for community-level PrEP education and outreach, and differing understandings of HIV risk/vulnerability. PrEP-users offered insights into current pathways into PrEP and need for increased awareness and access.
Despite significant PrEP work in Chicago, only 29% of women in our study had heard of PrEP. However PrEP attitudes among these women were positive, and once made aware of PrEP, one third considered starting in the near future. Translating these results into interventions which reflect women’s preferences and barriers are critical to increase PrEP uptake by cisgender women in Chicago.