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Social networks and their impact on women’s awareness, interest and uptake of HIV pre-exposure prophylaxis (PrEP)

Implications for Women Experiencing Intimate Partner Violence

In the United States, women represent less than 5% of all pre-exposure prophylaxis (PrEP) users. Social networks can promote or prevent women's PrEP awareness and their intentions. Intimate partner violence (IPV) may also affect how supportive women's networks can be. This study examined how network traits are associated with women's PrEP awareness, interest, uptake, and candidacy.

Women represent less than 5% of all PrEP users in the US
A total of 24.4% of women reported being PrEP-aware, 37.6% were interested in learning more about PrEP, 34.1% of the participants intended to use PrEP, and 2.4% reported using PrEP before. Women experiencing IPV had the highest prevalence of PrEP interest.

Extant research indicates low PrEP awareness among women, and our study found that having more PrEP-aware network members may increase women's awareness of PrEP. Social networks are an important vehicle for information and resource exchange among individuals and groups.

2016: women represented 19% of all new HIV diagnoses in the United States

Heterosexual contact accounted for 87% of HIV diagnoses among women

Women with IPV might not benefit from a social network experienced in PrEP.

Women with IPV might not benefit from a sLeveraging social networks might be a potential strategy to address the underutilization of PrEP for women, but our data suggest these interventions may be less effective for women experiencing IPV. For women who are not experiencing IPV, social network interventions designed to stimulate PrEP awareness and positive PrEP attitudes among network members might facilitate women's engagement in PrEP.ocial network experienced in PrEP.

Implications for women experiencing intimate partner violence

Background

In the U.S., women represent less than 5% of all pre-exposure prophylaxis (PrEP) users. Social networks may promote and/or inhibit women’s PrEP awareness, which could influence PrEP intentions. Women experiencing intimate partner violence (IPV) may have smaller, less supportive networks, which could deter or have no impact on PrEP care engagement. This study examined associations between network characteristics and women’s PrEP awareness, interest, uptake, and perceived candidacy; and analyzed IPV as an effect modifier.

Setting/Methods

From 2017 to 2018, data were collected from a prospective cohort study of 218 PrEP-eligible women with (n=94) and without (n=124) IPV experiences in Connecticut. Women completed surveys on demographics, IPV, social networks, and PrEP care continuum outcomes.

Results

Adjusted analyses showed that PrEP awareness related to having more PrEP-aware alters. PrEP intentions related to having more alters with favorable opinions of women’s potential PrEP use and a smaller network size. Viewing oneself as an appropriate PrEP candidate related to having more PrEP-aware alters and more alters with favorable opinions of women’s potential PrEP use. IPV modified associations between network characteristics and PrEP care. Having members who were aware of and/or used PrEP was positively associated with PrEP care engagement for women without IPV experiences, but had either no effect or the opposite effect for women experiencing IPV.

Conclusion

Improving PrEP attitudes might increase the amount of women using it. Social network interventions might be one way to increase PrEP uptake among many U.S. women, but may not be as effective for women experiencing IPV.