Women with substance use disorders (SUD) are at increased risk of HIV due to associated behaviors, such as injection of drugs, interactions with the criminal justice system, physical/sexual violence, and overlapping drug and sex networks.1 In 2017, the CDC reported that of the 38,739 HIV diagnoses in the United States and dependent areas, 1016 were among women who inject drugs.2

A recent qualitative study published in The Journal of the International Association of Providers for AIDS Care reveals that although pre-exposure prophylaxis (PrEP) has proven effective for HIV prevention, usage remains low in women with SUD.2 The researchers interviewed 20 women between ages 25 years and 62 years with SUD, and 15 stakeholders with direct patient contact with addiction services. All were affiliated with the largest drug treatment center in a mid-sized city in New England.
 
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Decreased PrEP usage was reportedly due to reduced awareness of prevention strategies, and engagement in health-promoting behaviors. The lack of action planning with their health also was a barrier that providers identified in women with SUD.

The study linked lack of motivation by women with SUD to 3 factors: competing priorities, minimization of risk perceived, and anticipated stigma.2 The women revealed the struggle of priorities and choosing basic survival needs—housing, finances—over HIV prevention. In addition, women consistently underestimated their risk for HIV, making prevention irrelevant.

Last, the researchers noted the stigma from partners and the community made women less likely to engage in healthy behaviors. Reduced administration of PrEP by providers may stem from their biases of this population.

Tenofovir, PrEP’s active drug, reaches lower concentrations in the vaginal or cervical tissue compared to rectal tissue.2 Given this pharmacology, adherence is essential for maximizing preventive benefit in women.

Overall, researchers concluded that a combination of information, motivation, and behavioral skills are necessary to engage in PrEP interventions. They believe that HIV prevention for women with SUD should be centered around long-term changes in the health system and drug treatment centers to facilitate PrEP usage and interventions.

 
Chevannah Hardie is a 2020 PharmD Candidate at the University of Connecticut in Storrs.



REFERENCES
  1. WOMEN'S HEALTH Qin Y, Price C, Rutledge R, Puglisi L, Madden LM, Meyer JP. Women's Decision-Making about PrEP for HIV Prevention in Drug Treatment Contexts. J Int Assoc Provid AIDS Care. 2020 Jan-Dec;19:2325958219900091
  2. HIV Among People Who Inject Drugs. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/group/hiv-idu.html. Published November 12, 2019. Accessed February 6, 2020.