Living at the Confluence of Stigmas: PrEP Awareness and Feasibility Among People Who Inject Drugs in Two Predominantly Rural States

Gregory Carter; Beth Meyerson; Patrick Rivers; Richard Crosby; Carrie Lawrence; Summer Dawn Cope; David DeBruicker; Steven Levin; Whitney Meeks; Christopher Thomas; Brooklyne Turner; Chris Abert; Haley Coles; Alicia Allen; Eduardo Gonzalez-Fagoaga; Ravi Grivois-Shah

doi:10.1007/s10461-021-03304-x

Living at the Confluence of Stigmas: PrEP Awareness and Feasibility Among People Who Inject Drugs in Two Predominantly Rural States

AIDS Behav. 2021 Oct;25(10):3085-3096. doi: 10.1007/s10461-021-03304-x. Epub 2021 May 18.

Authors

Gregory Carter^{1

2

3}, Beth Meyerson^{4

5

6}, Patrick Rivers⁵, Richard Crosby⁷, Carrie Lawrence⁸, Summer Dawn Cope⁹, David DeBruicker¹⁰, Steven Levin^{9

11}, Whitney Meeks¹⁰, Christopher Thomas^{9

11}, Brooklyne Turner¹⁰, Chris Abert^{10

12}, Haley Coles¹¹, Alicia Allen¹¹, Eduardo Gonzalez-Fagoaga¹³, Ravi Grivois-Shah¹⁴

Affiliations

¹ Department of Community and Health Systems, Indiana University School of Nursing, 1125 Atwater Ave, Bloomington, IN, 47401, USA. Gracarte@IU.edu.
² Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA. Gracarte@IU.edu.
³ School of Nursing, Indiana University, Bloomington, IN, USA. Gracarte@IU.edu.
⁴ Southwest Institute for Research On Women, College of Social and Behavioral Science, University of Arizona, Tucson, AZ, USA.
⁵ Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA.
⁶ Institute for LGBT Studies, University of Arizona, Tucson, AZ, USA.
⁷ Department of Health Behavior, College of Public Health, University of Kentucky, Lexington, KY, USA.
⁸ Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
⁹ Harm Reduction Foster Care Advocate, Tucson, AZ, USA.
¹⁰ Indiana Recovery Alliance, Bloomington, IN, USA.
¹¹ Sonoran Prevention Works, Phoenix, AZ, USA.
¹² Southwest Recovery Alliance, Phoenix, AZ, USA.
¹³ College of Public Health, University of Arizona, Tucson, AZ, USA.
¹⁴ Southern Arizona AIDS Foundation, Tucson, AZ, USA.

PMID: 34003385
DOI: 10.1007/s10461-021-03304-x

Abstract
in English, Spanish

We explored knowledge, beliefs, and acceptability of pre-exposure prophylaxis (PrEP) for HIV prevention with reference to stigma among people who inject drugs (PWID) in two predominately rural U.S. states. We conducted interviews with 65 current or former PWID aged 18 years or older and living in Arizona or Indiana. Most (63%) of the interviewees were not aware of PrEP. They often confused PrEP with HIV treatment, and many believed that PrEP was only for sexual risk or gay sexual risk. Once they understood that PrEP was recommended for PWID, the participants held a positive view of PrEP and felt that a once-daily pill was feasible. Experiences of stigma about drug use remained a crucial barrier to accessing healthcare and PrEP. This was often linked with anticipated or expressed homophobia. PrEP interventions among PWID must focus on education and the confluence of stigmas in which PWID find themselves when considering PrEP.

Exploramos el conocimiento, las creencias y la aceptabilidad de la profilaxis previa a la exposición (PrEP) para la prevención del VIH con referencia al estigma entre las personas que inyectan drogas (PWID) en dos Estados Unidos predominantemente rurales. estados. Realizamos entrevistas con 65 PWID actuales o anteriores de 18 años o más y viviendo en Arizona o Indiana. Más (63%) de los entrevistados no estaban al tanto de la PrEP. A menudo confundieron la PrEP con el tratamiento del VIH, y muchos creían que la PrEP era sólo por riesgo sexual o riesgo sexual gay. Una vez que entendieron que la PrEP se recomendaba para PWID, los participantes tenían una visión positiva de la PrEP y sentían que una vez-píldora diaria era factible. Las experiencias de estigma sobre el consumo de drogas siguieron siendo una barrera crucial para acceder a la atención médica y a la PrEP. Esto a menudo estaba relacionado con la homofobia anticipada o expresada. Las intervenciones de la PrEP entre PWID deben centrarse en la educación y la confluencia de estigmas en los que PWID se encuentra al considerar la PrEP.

Keywords: HIV prevention; Healthcare access; People who inject drugs; PrEP; Stigma.

MeSH terms

Anti-HIV Agents* / therapeutic use
Feasibility Studies
HIV Infections* / drug therapy
HIV Infections* / prevention & control
Humans
Pharmaceutical Preparations*
Pre-Exposure Prophylaxis*
Substance Abuse, Intravenous* / drug therapy

Substances

Anti-HIV Agents
Pharmaceutical Preparations

Abstract in English, Spanish

MeSH terms

Substances

Abstract
in English, Spanish