What Are the Factors That Make Women in the U.S. South Eligible for PrEP?

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Women of Color in the South and PrEP Use

Pre-exposure prophylaxis (PrEP) is a successful tool proven to prevent the transmission of HIV in those who take it daily. And while white men who have sex with men (MSM) have been reaping the benefits of this biomedical prevention, some of the people most in need of PrEP, including women living in the South, are not.

So what needs to be done to ensure that the women most vulnerable to HIV are being identified and made more knowledgeable about PrEP? And what are the demographic, sociobehavioral and clinical factors that made women the most likely candidates for PrEP?

At the Conference on Retroviruses and Opportunistic Infections (CROI) 2018, Anar Patel, M.D., a research fellow with Emory University, presented "Expanding PrEP In Women" to help answer these questions and identify a few solutions.

Kellee Terrell is the former news editor for TheBody.com and TheBodyPRO.com. Her work has appeared in the Huffington Post, Essence, Ebony, The Advocate, POZ and the Black AIDS Institute, to name a few. Follow her on Twitter @kelleent.

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Women in the Study: A Little Background

Using data from the Women's Interagency HIV Study (WIHS), the team identified a cohort of 245 cisgender high-risk HIV negative women in Birmingham, Alabama; Jackson, Mississippi; Miami, Florida; Chapel Hill, North Carolina; and Atlanta, Georgia. From there, 225 of them filled out a questionnaire about PrEP, which led researchers to conclude that 72 of those women -- roughly 32 percent -- were considered PrEP eligible.

Looking closer at the data, a majority of PrEP eligible women identified as African-American, had a low-income household, and were unmarried. More than 50 percent had health insurance, and an education level less than or equal to high school. In addition, the mean average of sexual partners was 3.1, and 11 percent had been diagnosed with an STI in the past year.

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Who Knows About the Power of PrEP?

Sadly, the answer is "very little." Of the 72 women, only a mere 4 (6 percent) had prior knowledge about PrEP and only one woman (less than 1 percent) had taken it before.

But there is some good news: When the women were told about PrEP and understood how it worked, a whopping 86 percent said they would be willing to take it if it was safe and effective. They also expressed interest in PrEP because it allowed them to take HIV prevention into their own hands, and that they didn't trust their sexual partners to be honest with them.

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What Makes These Women Eligible for PrEP?

Using the clinical guidelines on PrEP indications for women released in 2014 by the Centers for Disease Control and Prevention (CDC), researchers found that 43 percent of women in the study were having sex with partners of unknown HIV status, 27 percent partaking in inconsistent condom use, and 7 percent were having sex with a partner they knew was HIV-positive.

But beyond the CDC clinical factors, the team looked at other characteristics. They found that having a high school diploma or less, a history of sexual violence, and believing oneself to have a medium to high risk for HIV were associated with PrEP eligibility.

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How Can Providers Help More Women Get Access PrEP?

Researchers in the study noted that "extremely low awareness of PrEP despite high acceptability signifies a need to enhance PrEP education, screening and uptake for at-risk women."

Since there was a high desire to use PrEP once women were made aware of it, especially among women who saw themselves at medium-to-high risk, researchers concluded that clinicians and outreach workers must ask more questions about how these women perceive their own HIV-risk, whether they have a history of sexual violence, and their education levels given that all three are associated with PrEP eligibility.

In the end, the more health care providers know about these women's risk factors, the more access they will have to PrEP, which if the women adhere, could bring new infections down and truly impact this epidemic moving forward.