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A Qualitative Study of Barriers and Facilitators of PrEP Uptake Among Women in Substance Use Treatment and Syringe Service Programs

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Abstract

PrEP is an HIV prevention option that could benefit substance-involved women, a high-risk population with low PrEP uptake. Little is known about their interest in PrEP. This qualitative study used in-depth interviews to examine PrEP willingness, barriers, and facilitators among 16 women in outpatient psychosocial substance use treatment, methadone, and/or harm reduction/syringe programs in NYC. All expressed willingness to use PrEP, but only during periods of perceived risk. Women perceived themselves to be at high risk for HIV when engaging in active substance use and/or transactional sex. They perceived themselves to be at low risk and therefore unmotivated to take PrEP when abstinent from these activities. Paradoxically, a major barrier to using PrEP was anticipated interference from substance use and transactional sex, the very same activities that create a perception of risk. Facilitators of PrEP use included perceptions of it as effortless (as opposed to barrier methods during sex) and effective, safe, and accessible. Other barriers included fear of stigma and doubts about adhering daily. Recommendations for best PrEP implementation practices for substance-involved women included tailored and venue-specific PrEP information and messaging, PrEP discussion with trusted medical providers, and on-site PrEP prescription in substance use treatment and harm reduction programs.

Resumen

PrEP es una opción de prevención de VIH que puede beneficiar a las mujeres que consumen sustancias, una población de alto riesgo con baja aceptación de la PrEP, pero poco se sabe de su interés en la PrEP. Este estudio cualitativo utilizó entrevistas para examinar el interés en tomar la PrEP y las barreras y los facilitadores del uso de la PrEP entre 16 mujeres en tratamiento por el uso de sustancias en clínicas ambulatorias, clínicas metadonas, o programas de reducción de daños en la ciudad de Nueva York, Estados Unidos. Todas las participantes expresaron su disposición a usar PrEP, pero solo durante períodos de riesgo percibido (por ejemplo, tiempos de uso de sustancias activas y/o sexo transaccional). Paradójicamente, una barrera importante para el uso de PrEP fue la interferencia anticipada por el uso de sustancias y el sexo transaccional, las mismas actividades que crean una percepción de riesgo. Los facilitadores incluyeron percepciones de PrEP como sin esfuerzo durante las relaciones sexuales, efectiva, segura, y accesible. Otras barreras incluyeron el miedo del estigma y dudas sobre la adherencia diaria. Las recomendaciones para las mejores prácticas de implementar la PrEP para mujeres que consumen sustancias incluyeron información y mensajes de PrEP personalizados y específicos del lugar, discusión de PrEP con proveedores médicos confiables, y prescripción de PrEP en el sitio en programas de tratamiento y reducción de daños por uso de sustancias.

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Data Availability

Data and material can be made available on request as permitted by Institutional Review Board approval.

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Funding

This work was supported by a National Institute of Mental Health Center Grant (P30-MH43520; Remien, PI). Dr. Ertl was also supported by a National Institute of Mental Health Training Grant (T32-MH19139; Sandfort, PI) as well as a training grant funded by the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism (R25DA050687-01A1; Valdez, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of National Institute of Mental Health or the National Institutes of Health.

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Authors and Affiliations

  1. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, 722 West 168th Street, 10032, New York, NY, USA

    Susan Tross, Melissa M. Ertl & Susie Hoffman

  2. Department of Human Services, Stella and Charles Guttman Community College, City University of New York, New York, NY, USA

    Anya Y. Spector

  3. Albert Einstein College of Medicine, Bronx, NY, USA

    Hayley Berg

  4. New York State Psychiatric Institute, New York, NY, USA

    Eva Turrigiano

  5. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA

    Susie Hoffman

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  1. Susan Tross
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Contributions

Study conception and design: ST, SH; Data collection: ST, SH, HB, ET; Data coding and analysis: ST, SH, ET, HB, AS, ME; Manuscript preparation, ST, SH, AS, ME. Manuscript review and editing: ET, HB.

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Correspondence to Susan Tross.

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All study procedures and forms were reviewed and approved by the Institutional Review Board of New York State Psychiatric Institute at Columbia University Irving Medical Center.

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Tross, S., Spector, A.Y., Ertl, M.M. et al. A Qualitative Study of Barriers and Facilitators of PrEP Uptake Among Women in Substance Use Treatment and Syringe Service Programs. AIDS Behav 27, 1162–1172 (2023). https://doi.org/10.1007/s10461-022-03853-9

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