| Description: |
Background HIV prevention efforts in the US have primarily focused on men who have sex with men, limiting pre-exposure prophylaxis (PrEP) awareness and uptake among women. This study examines PrEP use among reproductive-age women without HIV (WWOH) enrolled in the Study of Treatment and Reproductive Outcomes (STAR), the largest cohort of reproductive-age women in the Southern US. Methods STAR is a longitudinal cohort of reproductive-age WWOH (eligible if aged 18-45 years and risk factors for HIV) in six cities (Miami, FL; Atlanta, GA; Chapel Hill, NC; Washington, DC; Birmingham, AL; Jackson, MS). Demographics, medical history, STI/HIV history, and PrEP use were self-reported. STI/HIV were assessed using commercially available tests. Results Among 362 WWOH eligible for PrEP, 36 (9.9%) reported ever using PrEP (24 current use and 12 prior use). Of those on PrEP who reported PrEP source, 6 obtained it through a clinical study, 12 from a healthcare provider, and 1 from non-medical sources. All participants who reported PrEP use had used tenofovir disoproxil/emtricitabine. Women who reported ever using PrEP were older (35 vs 31 years, p=0.001); the majority lived in Miami (53%, p=0.001); identified as non-Hispanic Black (66%, p=0.163); had an earlier sexual initiation (14.0 vs 15.8 years, p=0.004); reported more lifetime partners (34 vs 10, p=0.003); and had engaged in transactional sex in the prior 5 years (22% vs 10%, p=0.047). Though current STI rates (gonorrhea, chlamydia, syphilis, and trichomoniasis) did not differ by PrEP use, prior syphilis and chlamydia were higher among those who had ever used PrEP (19% vs 4.3%, p=0.002 and 58% vs 34%, p=0.007). Reasons to discontinue PrEP included medication cost (12, 100%), provider access (12, 100%), and periodic use (12, 100%). Conclusion Despite high vulnerability to HIV among reproductive-age women in the Southern US, PrEP use was low in this sample, and discontinuation high. Affordable and accessible novel modes of PrEP delivery, and investigation on ... |