Predictors of Willingness to Diffuse PrEP Information within Ego-Centric Networks of Women Who Inject Drugs in Philadelphia, PA, USA
Marisa Felsher, Emmanuel Koku, Scarlett Bellamy, Krystal Santiago, Alexis RothIntroduction: Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy that involves the use of daily antiretroviral medications by HIV-negative individuals. However, PrEP awareness and uptake is low among many populations that may benefit from it, including women who inject drugs (WWID). One method of increasing PrEP awareness and uptake, which has been successful with other HIV prevention strategies, is peer influence models wherein interpersonal communication within networks is used to provide information about and support for an innovation. There is a dearth of studies exploring the potential of interpersonal communication between WWID and their network members to facilitate PrEP information exchange and support. This study uses ego-centric network analysis to identify how characteristics of relationships impact women who inject drugs’ (WWID) willingness to share information about pre-exposure prophylaxis (PrEP) for HIV prevention with network members.
Methods: Eligible participants were biologically female, HIV-negative, >eighteen years old, and participating in PrEP implementation study in Philadelphia, PA, USA. Participants completed a personal network survey that included measures of alter attributes (e.g. alters’ gender) and dyadic characteristics (e.g. emotional closeness within relationships). The primary outcome was willingness to share information about PrEP with each alter.
Results: Participants (n=40) named on average 9.3 (SD=±3.3) network members which resulted in a total of 375 unique relationships. WWID were willing to share PrEP information with 83% of people in their social network. In a multivariable model, participants had higher odds of willingness to share PrEP information within relationships where the network member was female (aOR: 3.74; 95% CI 1.20-11.63), homeless (aOR: 2.77; 95% CI 1.02-7.52), and perceived by respondent to be at risk for HIV (aOR: 4.22; 95% CI 1.62-11.07). We also tested an interaction between emotional closeness and relationship type on willingness to share PrEP information. The interaction was significant and positive with transactional sex clients and family, suggesting that stronger emotional closeness was associated with higher probability of willingness to share PrEP Information within those two relationship types.
Conclusions: WWID are willing to share PrEP information with the majority of network members, many of whom are perceived to be at risk for HIV. Important dyadic characteristics such as gender homophily and perceptions of HIV risk are positively associated with willingness to share PrEP information. Peer interventions where WWID share PrEP information with network members, in particular other women, may be a feasible approach to increase PrEP awareness among highly vulnerable populations.