Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment

- We examined the willingness of people who use drugs (PWUDs) to initiate pre-exposure prophylaxis (PrEP).
- We also examined the anticipation of HIV risk reduction among PWUDs.
- 18% reported having heard of PrEP and 62.7% reported being willing to initiate PrEP.
- PrEP willingness was associated with NCI and higher perceived risk for HIV infection.
- We found anticipated higher risk behaviors among this sample while on PrEP.

BackgroundAlthough people who use drugs (PWUD) are key populations recommended to receive pre-exposure prophylaxis (PrEP) to prevent HIV, few data are available to guide PrEP delivery in this underserved group. We therefore examined the willingness to initiate PrEP and the anticipation of HIV risk reduction while on PrEP among high-risk PWUD.MethodsIn a cross-sectional study of 400 HIV-negative, opioid dependent persons enrolled in a methadone program and reporting recent risk behaviors, we examined independent correlates of being willing to initiate PrEP.ResultsWhile only 72 (18%) were aware of PrEP, after being given a description of it, 251 (62.7%) were willing to initiate PrEP. This outcome was associated with having neurocognitive impairment (aOR = 3.184, p = 0.004) and higher perceived HIV risk (aOR = 8.044, p < 0.001). Among those willing to initiate PrEP, only 12.5% and 28.2%, respectively, indicated that they would always use condoms and not share injection equipment while on PrEP. Consistent condom use was associated with higher income (aOR = 8.315, p = 0.016), always using condoms with casual partners (aOR = 6.597, p = 0.001), and inversely associated with ongoing drug injection (aOR = 0.323, p = 0.027). Consistent safe injection, however, was inversely associated with age (aOR = 0.948, p = 0.035), ongoing drug injection (aOR = 0.342, p < 0.001), and perceived HIV risk (aOR = 0.191, p = 0.019).ConclusionsWhile willingness to initiate PrEP was high and correlated with being at elevated risk for HIV, anticipated higher risk behaviors in this group even while on PrEP suggests that the next generation of HIV prevention approaches may need to combine biomedical and behavioral components to sustain HIV risk reduction over time.