Perspectives of women prescribed HIV pre-exposure prophylaxis (PrEP)

Abstract

Background

Pre-exposure prophylaxis (PrEP) is an innovative HIV prevention strategy that involves taking a pill a day to stay HIV-negative. Despite being the only HIV prevention method that can be both used and controlled by women, PrEP remains vastly underutilized by women. As such, among women prescribed PrEP, little is known about their perspectives and experiences with this new HIV prevention tool.

Methods

The study took place at a community-based comprehensive sexual health clinic that offers PrEP care. The clinic is a part of the largest health care system in the Bronx, NY. We recruited cisgender women who have sex with men and who received at least one prescription for daily oral PrEP. We conducted individual semi-structured interviews and asked women their reasons for PrEP and benefits and challenges they encountered taking PrEP. Interviews were audiotaped and professionally transcribed. We used grounded theory and the constant comparative method to identify emergent themes.

Results

Among our sample ( n = 12), median age was 39 years (range: 35–49); most women were either Latina or non-Latina Black. Women learned about PrEP from within the healthcare system or in the community. Most women were in a known sero-discordant partnership while few reported having multiple partners with unknown HIV status. Women felt that PrEP allowed them to “stay healthy” and, for those with positive partners, PrEP enabled them to maintain their relationships while remaining negative. With regards to their sex lives, PrEP allowed some to feel more connected to their partners in part because they felt they could forgo condoms. In contrast, PrEP provided “an extra layer of protection” for others when used with condoms and decreased HIV-related anxiety. Despite these benefits, many perceived PrEP-related stigma. Most did not disclose their PrEP use to others for fear that they would be assumed as HIV-positive or promiscuous, or be judged for being in a sero-discordant relationship.

Conclusion

While experiences with PrEP centered on maintaining health, improved intimacy, and reduced HIV-related anxiety, PrEP-related stigma was common. Future research should ascertain what role stigma may play in U.S women’s PrEP uptake, persistence, and adherence and how stigma can be effectively addressed in future PrEP-related interventions.

Disclosures

All authors: No reported disclosures.