HIV biomedical prevention knowledge, attitudes, and behaviors among U.S. women enrolled in a longitudinal cohort study 2014–2019
Year: 2025
Type: article
Abstract: BACKGROUND: Pre-exposure prophylaxis (PrEP) was approved for use in the US in 2012 and cross-sectional analyses show low uptake among women. However, use of PrEP over time has not been characterized in women. Longitudinal assessments are needed to characterize PrEP use and eligibility. METHODS: We conducted a nested cross-sectional survey (April 2014-October 2015) to assess post-exposure prophylaxis (PEP)/PrEP knowledge, attitudes, and PEP/PrEP use among cisgender women without HIV enrolled in the Women's Interagency HIV Study (WIHS). As few women reported PEP/PrEP use we assessed willingness to use PEP/PrEP. Longitudinally, we determined PrEP use and eligibility based on CDC guidance using semi-annual self-reported risk behaviors collected from 2014 to 2019. We used logistic regression to identify factors associated with willingness to use PrEP. RESULTS: Among the 716 women who completed the survey the median age was 46 years (IQR 38, 53) and 72% were Black. At baseline, 43% (n = 46/108) of PrEP-eligible women self-identified as medium-high risk for HIV while 8% (n = 47/593) of non-eligible women believed they were at high risk. 36% (n = 264/731) of women were eligible for PrEP at some point between 2014 and 2019. However, only 3% (n = 22/731) of women reported PrEP use. Older age (aOR 0.97 95% CI 0.95-0.99) and ambivalence/shame (aOR 0.37 95% CI 0.16-0.90) were associated with lower willingness to use PrEP. Belief that PrEP prevents HIV infection (aOR 27.03 95% CI 9.68-75.46) and self/healthcare provider-initiated HIV testing in the prior 2-years (aOR 1.76 95% CI 1.15-2.68) were associated with willingness to use PrEP. CONCLUSIONS: PrEP uptake among women remains low despite availability and willingness to take PrEP. Eligibility for PrEP varied over time and self-perception of risk was not always congruent with guidelines. Continued efforts are needed to identify those that would benefit from HIV prevention services during routine medical care and develop interventions to increase PrEP prescribing and use.
Source: BMC Public Health
Institutions: Georgetown University Medical Center, George Washington University, University of Miami, Johns Hopkins University, Hektoen Institute, University of California, San Francisco, Albert Einstein College of Medicine, Montefiore Health System, University of Mississippi Medical Center, State University of New York, SUNY Downstate Health Sciences University, Emory University
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,290
Funders: Georgia Clinical and Translational Science Alliance, National Institutes of Health, University of California, San Francisco, National Institute on Alcohol Abuse and Alcoholism, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, National Cancer Institute, National Institute on Deafness and Other Communication Disorders, National Institute of Nursing Research, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, National Institute of Dental and Craniofacial Research, National Center for Advancing Translational Sciences, National Institute on Minority Health and Health Disparities, Clinical and Translational Science Institute, University of California, Los Angeles
Awards: Translational Biomedical Science Training Grant, G1655989834, G1773452051, G183157880, G2127051194, G248584506, G2755707676, G2839061624, G30074556, G3242306066, G3418878615, G343705321, G483408255, G5431849782, University of Miami Developmental HIV/AIDS Mental Health Research Center (D-ARC), G693265041, Johns Hopkins Institute for Clinical and Translational Research, MACS/WIHS -CCS, UNC MACS/WIHS Combined Cohort Study Clinical Research Site, Surviving the HIV Epidemic (S/HE) in metropolitan Washington DC - Advancing knowledge through cohort studies, Center for AIDS Research at Emory University, Data Analysis and Coordination Center for the MACS-WIHS Combined Cohort Study, The University of North Carolina Center for AIDS Research, MACS/WIHS Combined Cohort Study: Brooklyn Clinical Research Site (Bklyn CRS), UAB-MISS MACS/WIHS Combined Cohort Study, UCLA Clinical and Translational Science Institute, Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS), UAB Center for AIDS Research (CFAR)
OpenAlex ID: W4414626034