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Focus Groups - 2015 - WIHS-Wash DC - Women want Pre-Exposure Prophylaxis but are Advised Against it by Their HIV-positive Counterparts
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2015 - Lakshmi Goparaju*, Laure S Experton, Nathan C Praschan, Lari Warren-Jeanpiere, Mary A Young and Seble Kassaye Georgetown University, Washington DC, USA
Even though the participants of this study live in the nation’s capital that has high HIV prevalence [26], their knowledge of PrEP was little to non-existent. Lack of awareness and information about PrEP seems to be a major barrier for uptake at this time; it is imperative to bolster PrEP awareness.
We conducted focus groups segregated by HIV sero-status with Washington DC WIHS women during February - May 2014. At the time of this study, there were 309 active participants in the DC WIHS site; of them 218 were HIV-positive and 91 were high risk HIV-negative. A recruitment letter was sent to the participants informing them about the study. An announcement was also placed in the DC WIHS newsletter.
Key topics discussed in the focus groups and presented in this paper include HIV-negative women’s experiences with HIV; perceptions of their own risk of HIV infection; HIV-negative and HIV-positive women’s awareness of PrEP; acceptability of PrEP; preferred HIV prevention method; concerns about the PrEP package; and potential target groups for PrEP outreach. Focus group guidelines were developed around these topics, and modified based on the discussions. The main topics were discussed in all groups. After ascertainment of prior knowledge of PrEP, a script based on CDC guidance documents [25] was read to the participants describing what is PrEP, FDA’s approval of PrEP and the different aspects of the comprehensive PrEP package. This was then followed by further discussion to understand women’s thoughts and concerns about PrEP. The lead author moderated all the focus group discussions.
Objectives: The latest advancement in HIV prevention, Pre-Exposure Prophylaxis (PrEP), could reduce incidence among women. However, PrEP uptake has remained low among US women since its approval in 2012, while use has increased among men who have sex with men. This study addresses women’s knowledge, attitudes and potential behaviors regarding PrEP. While HIV-negative women are the potential users of antiretroviral (ARV) medications for PrEP, HIV-positive women who have used ARVs could contribute immensely to our understanding of the complexities related to taking such medications. This study is the first to synthesize the opinions of both groups of women.
Methods: We conducted eight focus group discussions, segregated by sero-status; four with at-risk HIV-negative (20) and four with HIV-positive (19) women in Washington DC during 2014. Topics discussed include PrEP awareness, likelihood of use, barriers and target populations.
Results: PrEP awareness was almost non-existent and the HIV-negative women urged publicity. They expressed much enthusiasm about PrEP and wanted to use and recommend it to others despite recognizing potential complexities related to taking PrEP, such as side effects, access, duration and frequency of use. HIV-positive women were less supportive of PrEP for those same reasons based on their experience with taking ARVs. They preferred condoms over PrEP given relative efficacy, affordability, accessibility, and prevention of other STIs.
Conclusions: There is an urgent need for PrEP public health campaigns catered to the needs and concerns of women, most importantly bolster their awareness of PrEP.

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