Racial and ethnic differences in women's HIV risk and attitudes towards pre-exposure prophylaxis (PrEP) in the context of the substance use, violence, and depression syndemic

AIDS Care. 2021 Feb;33(2):219-228. doi: 10.1080/09540121.2020.1762067. Epub 2020 May 14.

Abstract

Women with syndemic conditions, i.e., two or more co-occurring epidemics, are at elevated risk for HIV acquisition and are therefore prime candidates for pre-exposure prophylaxis (PrEP). However, PrEP uptake remains low among women, especially among Black and Hispanic women. This study examined associations of syndemic conditions with PrEP attitudes and HIV risk among women, and the moderating effect of race and ethnicity. In 2017, 271 non-Hispanic Black, non-Hispanic White, and Hispanic, PrEP-eligible women engaged in care at Planned Parenthood in the northeastern region of the U.S. completed an online survey. Participants reported syndemic conditions (i.e., intimate partner violence, depression, substance use), PrEP attitudes (e.g., PrEP interest), HIV sexual risk (e.g., multiple male sexual partners), and sociodemographics. Structural equation modeling was used to examine the effects of syndemic conditions on PrEP attitudes and HIV risk, and the moderating effect of race and ethnicity. Women with more syndemic conditions had a higher odds of reporting multiple male sexual partners. Syndemic conditions were positively associated with PrEP attitudes for Hispanic women than non-Hispanic Black and White women. Women with syndemic conditions, particularly Hispanic women, may be receptive to interventions promoting PrEP.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Anti-HIV Agents / administration & dosage*
  • Anti-HIV Agents / therapeutic use
  • Attitude
  • Black People / statistics & numerical data
  • Depression / ethnology
  • Depression / psychology*
  • Ethnicity
  • Female
  • HIV Infections / ethnology
  • HIV Infections / prevention & control*
  • Health Knowledge, Attitudes, Practice*
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Pre-Exposure Prophylaxis*
  • Substance-Related Disorders / ethnology*
  • Substance-Related Disorders / psychology
  • Syndemic
  • Violence / ethnology
  • Violence / psychology*
  • White People / statistics & numerical data

Substances

  • Anti-HIV Agents