Factors that Influence Perception of HIV Risk and Willingness to Use Pre-Exposure Prophylaxis in People Who Inject Drugs

Abstract

Introduction: Sexual and injection behaviors increase the risk of HIV transmission in people who inject drugs (PWID). We aimed to determine the prevalence of sexual and drug behaviors that increase HIV risk in PWID hospitalized for infections related to injection drug use in Maine. We also examined factors that influenced their perception of HIV risk and willingness to take pre-exposure prophylaxis (PrEP). Methods: We surveyed 101 PWID with infections related to injection drug use who were hospitalized at 4 hospitals in Maine. T-tests assessed differences in means of bacterial infection risk scores and willingness to take PrEP based on different sociodemographic factors. Results: PWID engaging in unsafe sexual behavior had a higher mean score of bacterial infection risk than those engaging in safer sexual behavior (3.90 vs 3.07; P = .06). PWID with lower educational attainment had a lower mean score of willingness to take PrEP than those with a higher educational attainment (3.19 vs 3.85; P = .02). Willingness to take PrEP was positively associated with the level of educational attainment (odds ratio, 2.14; 95% CI, 1.01-4.93; P = .048). Discussion: Our findings associated willingness to take PrEP with educational attainment. To prevent HIV infection, harm reduction programs that discuss risk behaviors with PWID could be expanded, especially in rural areas where people have lower educational levels. Conclusions: We found that injection and sexual risk behaviors co-occurred in PWID, PWID had an overall perception of low HIV risk, and willingness to take PrEP was positively associated with the level of educational attainment.