People Who Inject Drugs Have Low Knowledge of and Mixed Interest in HIV Pre-Exposure Prophylaxis

People who inject drugs (PWID) have high rates of sexual and injection-related HIV risk behavior, but HIV pre-exposure prophylaxis (PrEP) uptake among PWID remains low. Researchers conducted semi-structured interviews with HIV-uninfected PWID (n=33) and key informants (providers and community-based organization staff, n=12) to assess PrEP knowledge and interest among PWID.

  • PWID who participated were young (mean age=33), male (55%), and white (67%).
  • PrEP knowledge among PWID was low.
  • Key informants identified the following contributors to low knowledge:
    • Marketing efforts targeting other populations (e.g. men-who-have-sex-with-men) that do not feel relevant to PWID.
    • Barriers faced by providers in discussing PrEP, including time constraints and competing clinical priorities.
    • Low provider willingness to offer PrEP to PWID due to stigma and assumptions about medication adherence.
  • Interest in PrEP among PWID was mixed. Low interest was driven by a low perception of HIV risk, but significant discrepancies between perceived risk and self-reported risk behaviors were identified.

Comments: Recent HIV outbreaks have demonstrated how quickly HIV can spread through injection networks in the era of short-acting fentanyl, making increased PrEP utilization by PWID an urgent priority. Low PrEP knowledge and inaccurate self-assessment of HIV risk are two important targets for future interventions to increase PrEP uptake. Educational interventions for PWID must be tailored to this population in terms of content and access (i.e. availability at sites where PWID already access services). Interventions should also support increased PrEP counseling and prescribing capacity among providers who work with PWID.

Jessica L. Taylor, MD

Reference: Bazzi AR, Biancarelli DL, Childs E, et al. Limited knowledge and mixed interest in pre-exposure prophylaxis for HIV prevention among people who inject drugs. AIDS Patient Care STDs. 2018;32(12):529–537.

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