As the opioid crisis continues to grip the United States, concerns about infectious disease transmission resulting from injection drug use, especially the spread of HIV, have been reinvigorated. PrEP (pre-exposure prophylaxis) is an effective tool to prevent the spread of HIV, but in the United States, to date it has been primarily initiated by men who have sex with men.
Researchers at the Brown University School of Public Health and the Boston University School of Public Health wanted to find out more about knowledge of and interest in PrEP among people who inject drugs (PWID) in Providence, RI and Boston, MA. They found very low knowledge of PrEP and mixed interest in using it among PWID in these two cities.
Between October 2016 and October 2017, PWID and key informants (PrEP and harm reduction providers) were interviewed in Boston and Providence. In all, 33 PWID and 12 professional key informants were interviewed. PWID were asked about their substance use, HIV risk as well as about PrEP knowledge and interest. After being asked about their knowledge on PrEP, participants were provided a brief overview of the antiretroviral pill.
Researchers found that knowledge of PrEP was low among PWID, with most people reporting never having heard about it, and only a few learning of it from community based organizations, websites, or friends. Key informants shared some insight into this finding, speculating that low knowledge may be due to PrEP advertising and outreach being targeted mainly towards MSM, and the possibility that health care providers don’t talk about PrEP with PWID because they are more focused on addiction or mental health issues. They also reported that assumptions about PWID having poor medication adherence could discourage health care providers from suggesting PrEP, which involves taking a daily oral pill.
When discussing PrEP interest, many participants expressed interest in using PrEP in the future. Level of interest was highly related to their perceived risk for contracting HIV. Among those who reported lower levels of interest, some explained that they were careful with how they used needless and did not engage in unsafe and risky sexual practices. However, after further conversation, some described occasionally sharing syringes or engaging in condomless sex or transactional sex. Conversely, those who more directly acknowledged HIV risk behaviors had higher interest in PrEP.
This study demonstrated the lack of knowledge about PrEP among PWID. As the opioid crisis grows, the authors stress that more research will be urgently needed to assess and design interventions to help increase PrEP knowledge and uptake in this vulnerable population.