A Retrospective Assessment of Antecedent Pre-Exposure Prophylaxis Eligibility of HIV-Positive Women in the South

Abstract

African American women disproportionately endure the predominance of HIV infections among women, especially in the South. HIV pre-exposure prophylaxis (PrEP) is recognized as an effective prevention strategy for individuals at higher risk of HIV acquisition. Accordingly, PrEP is recommended in heterosexually active adult persons who are HIV negative; not in a monogamous relationship with an HIV-negative partner; and infrequently use condoms with a partner who is a bisexual male, HIV positive, or uses recreational intravenous (IV) drugs. Despite PrEP's acceptance among other groups at higher risk of HIV acquisition, studies indicate low use among African American women in the South. It is unclear whether underutilization results from a low perceived risk of HIV infection or from miscalculation of risk by clinicians. To ascertain the fitness of current PrEP indicators to evaluate HIV acquisition risk in heterosexual women, 102 HIV-positive women in Atlanta, GA, were queried about their awareness of and participation in higher risk heterosexual relationship dynamics before their HIV diagnosis. Risk awareness and behaviors were retrospectively assessed to determine whether the same women, now HIV positive, would have been considered for PrEP before their HIV diagnoses. When queried, 66% reported having only one sexual partner, 64% reported having sex ≥4 times with the partner from whom they acquired HIV, and >90% reported no knowledge of their partners' HIV-positive status or bisexual orientation. As demonstrated, heterosexual women with only one sexual partner and limited awareness of their partners' HIV-positive status or bisexual orientation remain at substantial risk of HIV acquisition without suitable risk approximation strategies.