Multilevel Factors Shaping Awareness of and Attitudes Toward Pre-exposure Prophylaxis for HIV Prevention among Criminal
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ORIGINAL PAPER
Multilevel Factors Shaping Awareness of and Attitudes Toward Pre‑exposure Prophylaxis for HIV Prevention among Criminal Justice‑Involved Women Emily F. Dauria1 · Andrew Levine2 · Samantha V. Hill3 · Marina Tolou‑Shams1 · Katerina Christopoulos4 Received: 21 March 2020 / Revised: 26 August 2020 / Accepted: 3 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Although pre-exposure prophylaxis (PrEP) is a key tool in HIV prevention efforts, little is known about PrEP as a prevention strategy for criminal justice-involved (CJI) women. The purpose of this study was to examine multilevel factors shaping PrEP awareness and acceptability among CJI women. Between January 2017 and December 2017, we conducted 52 interviews with CJI women at high risk for HIV and stakeholders from the criminal justice (CJ) and public health (PH) systems. Interviews explored awareness of PrEP and the multilevel factors shaping PrEP acceptability. Data were analyzed using inductive thematic analysis and executive summaries. Atlas.ti facilitated analyses. The majority of CJI women (n = 27) were, on average, 41.3 years, from racial and ethnic minority groups (56% Black/African-American; 19% Latinx) and reported engaging in recent high-risk behavior (nearly 60% engaged in transactional sex, 22% reported ≥ 4 sexual partners, and 37% reported injection drug use). Of system stakeholders (n = 25), 52% represented the CJ sector. Although CJI women were generally unaware of PrEP, attitudes toward PrEP were enthusiastic. Barriers to PrEP acceptability included medication side effects (individual level); distrust in HIV prevention mechanisms (community level); lack of local HIV prevention efforts among high-risk women (public policy/HIV epidemic stage level). Factors promoting PrEP included perceived HIV risk (individual level); PrEP being an HIV prevention method that women can control without partner negotiation (social and sexual network level); and availability of public health insurance (community level). Despite low awareness of PrEP, CJI women expressed positive attitudes toward PrEP. To improve PrEP access for CJI women, implementation efforts should address barriers and leverage facilitators across multiple levels to be maximally effective. Keywords Incarceration · Women’s health · HIV prevention · PrEP
Introduction More than one million women are involved in the U.S. criminal justice (CJ) system annually (United States Bureau of Justice Statistics, 2019). Women involved in the CJ system are * Emily F. Dauria [email protected] 1
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Ave., Bldg. 5, San Francisco, CA 94110, USA
2
Department of Sociology, New York University, New York, NY, USA
3
Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
4
Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
particularly vulnerable to and expe
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