Women's perspectives on barriers to potential PrEP uptake for HIV prevention: HIV risk assessment, relationship dynamics and stigma.

HIV remains a significant health issue for women, and multiple overlapping factors shape women's HIV-related risk. Pre-exposure prophylaxis (PrEP) offers critical advantages over other existing options, yet it remains significantly underused among women in the USA where limited work has explored women's opinions on barriers to potential PrEP use. Using open-ended text responses from a sample of women seeking care at a US urban family planning health centre, this study aimed to understand perceptions of factors affecting potential PrEP use. Three themes concerning key factors impacting potential PrEP use emerged: HIV risk assessment, relationship dynamics, and anticipated stigma. Women's assessment of HIV risk suggests that identifying women in clinical settings as having low self-perceived risk may overlook the complexity of how women determine HIV-related risk and prevention needs. Women frequently referenced relationship dynamics when considering PrEP and discussed anticipated partner reactions about use contributing to non-use. Fear or worry of stigma were expressed as motivations to not use PrEP. Study results highlight the importance of public health and health care professionals normalising PrEP as a strategy in women's HIV prevention and sexual health decision-making. Woman-centred PrEP education, screening and communication strategies reflective of their unique HIV-related risk context are needed.

Intersection of Intimate Partner Violence and Pre-Exposure Prophylaxis: Exploring HIV Worry and PrEP Acceptability Among Women.

This article examines the prevalence of recent and lifetime intimate partner violence (IPV) and association with pre-exposure prophylaxis (PrEP) acceptability among women seeking care at an urban family planning clinic (N = 145). We found high prevalence of recent (40%) and lifetime IPV (71%). Almost a third of participants reported being worried about HIV risk, 70% were willing to take PrEP, and 71% of women who disclosed recent IPV were willing to take PrEP. Findings provide direction for research, practice, and policy attention needed around the context of IPV to focus development of a woman-centered PrEP intervention.

Intimate Partner Violence, HIV Pre-Exposure Prophylaxis (PrEP) Acceptability, and Attitudes About Use: Perspectives of Women Seeking Care at a Family Planning Clinic.

Pre-exposure prophylaxis (PrEP) presents an opportunity to expand prevention options for women at risk for HIV infection. Yet, women's PrEP use remains low and relatively little is known about PrEP acceptability and attitudes among a sub-population of women at risk for HIV-those experiencing intimate partner violence (IPV). A cross-sectional survey included closed and open-ended questions to assess IPV, PrEP acceptability, and attitudes about PrEP use among women seeking care at an urban family planning clinic in Pittsburgh, Pennsylvania (N = 145). Approximately 70% of women reported being willing to use PrEP with the key reasons for potential use including previous STI diagnosis, inconsistent condom use, and lack of or dishonest conversations with partners. Among women reporting recent IPV (41%), potential barriers to PrEP included concerns around drug effects, access/affordability, and adherence. Over half of women reporting recent IPV reported concerns around partner reaction impacting potential PrEP use. Results from this mixed-methods study highlight the need for a woman-centered PrEP intervention that uniquely includes awareness raising and understanding of PrEP for women, as well as reflects the context of IPV in decision-making and care.

Client perspectives on an outreach approach for HIV prevention targeting Indonesian MSM and transwomen.

This study explored clients' perspective on an outreach approach to promote HIV testing in Indonesia targeting men who have sex with men (MSM) and transgender women (transwomen or waria). Semi-structured qualitative interviews were conducted with 32 individuals (21 MSM and 11 waria) who had received services from outreach workers (OWs) in five cities in Indonesia. Participants in this study reported positive experiences with the outreach approach and perceived OWs as their motivators in accessing HIV testing as well as HIV care and treatment. OWs provided easy-to-understand HIV information. Clients expected OWs to be well-trained and more creative in performing outreach. They perceived that the Internet and social media have helped them considerably to stay in touch with OWs. Yet, they expressed that such virtual contacts could not simply replace the face-to-face contact, especially for waria. Furthermore, clients suggested outreach to be delivered in a more appealing manner, for example through activities that may facilitate clients learning professional or life skills. They also asserted that as an HIV prevention approach, outreach needs to use more positive framing and go beyond HIV and health contents, chiefly for the youth. Future outreach programmes should facilitate OWs in providing tailored services based on the level and type of support that the clients need, and in applying varied proportion and levels of sophistication in the use of online and virtual platforms for outreach.

Intimate Partner Violence and Pre-exposure Prophylaxis (PrEP): A Rapid Review of Current Evidence for Women's HIV Prevention.

Pre-exposure prophylaxis (PrEP) is a valued component of HIV prevention and increasing attention is focusing on women's PrEP use. Common HIV prevention options (e.g., condoms) remain underused and fail to consider the context of intimate partner violence (IPV). PrEP presents an opportunity to expand viable options for women. A systematic rapid review using key word searches of PubMed and proceedings from six national and international conferences related to HIV, women's health, or interpersonal violence identified nine studies which met set inclusion criteria. Studies were coded using a structured abstraction form and summarized according to relevant themes. IPV was found to have implications on women's interest and willingness to use PrEP, partner interference or interruptions in PrEP use, and adherence. Findings indicate a dearth of research on women's PrEP use and IPV and highlight the urgency for research, public heath practice, and policy attention around the HIV risk context and needs of women who experience IPV.

High HIV incidence among young black men who have sex with men: constructing a retrospective cohort from a community health programme.

OBJECTIVES: We sought to calculate HIV incidence in a retrospective cohort of young (13-29 years old) black men who have sex with men (YBMSM) accessing repeated HIV-antibody testing in a mid-size city in the USA. METHODS: We aggregated site-specific HIV-antibody testing results from the project's inception among YBMSM who received an initial negative result and accessed at least one additional HIV-antibody test. From these data, we assessed number of seroconversions and person-years and calculated HIV incidence using a mid-P exact test to estimate 95% CIs. RESULTS: Five seroconversions were documented over 42.3 person-years (the mean age at first onsite test: 19.7 years), resulting in an HIV incidence rate of 11.8% (95% CI 4.3% to 26.2%). The mean age at seroconversion was 20.4 (±3.0) years. CONCLUSIONS: Even in mid-size cities with low HIV prevalence rates in the general population, HIV incidence among YBMSM may be high. Community-based HIV-antibody testing organisations serving YBMSM should be encouraged and trained to track repeated HIV testing and calculate HIV incidence rates. Increased resources should be deployed to develop and encourage regular HIV testing in community health sites serving YBMSM.