HIV Risk and Interest in Preexposure Prophylaxis in Justice-Involved Persons

Abstract

Preexposure prophylaxis (PrEP) is underused in persons who use drugs and justice-involved persons. In an ongoing randomized controlled trial in 4 US locations comparing patient navigation versus mobile health unit on time to initiation of HIV medication or PrEP for justice-involved persons who use stimulants or opioids and who are at risk for or living with HIV, we assessed HIV risk factors, perceived HIV risk, and interest in PrEP. Participants without HIV (n = 195) were 77% men, 65% White, 23% Black, and 26% Hispanic; 73% reported a recent history of condomless sex, mainly with partners of unknown HIV status. Of 34% (67/195) reporting injection drug use, 43% reported sharing equipment. Despite risk factors, many persons reported their risk for acquiring HIV as low (47%) or no (43%) risk, although 51/93 (55%) with PrEP indications reported interest in PrEP. Justice-involved persons who use drugs underestimated their HIV risk and might benefit from increased PrEP education efforts.

Keywords: HIV; HIV risk; PWID; PrEP; STIs; hepatitis C; incarcerated; justice system; justice-involved population; persons who inject drugs; preexposure prophylaxis; sexually transmitted infections; substance use; viruses.

Figure 1

Venn diagram showing indications for preexposure prophylaxis among participants in study of HIV risk and interest in preexposure prophylaxis for HIV-negative justice-involved populations in Texas (Dallas and Fort Worth) and Connecticut (northeast and southeast), USA, March 2022–May 2023. Condomless sex and shared IDU equipment are based on baseline responses with 30-day lookback; recent STI is based on self-report at baseline for STIs diagnosed during the past year. IDU, injection drug use; STI, sexually transmitted infection.

Figure 2

Self-perceived HIV risk overall and by reported risk factors among participants without HIV enrolled in study of HIV risk and interest in preexposure prophylaxis for HIV-negative justice-involved populations in Texas (Dallas and Fort Worth) and Connecticut (northeast and southeast), USA, March 2022–May 2023. Participants answered “what is your current risk for HIV acquisition (no, low, medium or high risk)?” Condomless sex and shared IDU equipment are based on baseline responses with 30-day lookback; recent STI is based on self-report at baseline for STIs diagnosed during the past year. IDU, injection drug use; STI, sexually transmitted infection.