Considerations of HIV PrEP Among Heterosexually Active Women and Men: Results from a Qualitative Study in New York City

Although 22% of new HIV diagnoses in the United States are attributed to heterosexual contact, uptake of pre-exposure prophylaxis (PrEP) remains low among heterosexually active women and men, and information about PrEP considerations in this population is scarce. We report on a cross-sectional qualitative study that explored attitudes towards PrEP among a diverse sample of 50 heterosexually active cisgender adults (31 women, 19 men) in New York City. We categorized factors influencing PrEP attitudes along social-ecological levels: societal (e.g., social marketing), community (e.g., health care organizations and providers), interpersonal (e.g., friends and sexual partners), and individual (e.g., personal beliefs and preferences). About two-thirds had previously heard of PrEP, but a few had inaccurate or lacking knowledge of it, and none had ever used it. Many participants had learned about PrEP through marketing and social interactions, from which many perceived that PrEP was mainly indicated for gay or bisexual men and transgender individuals. Most participants had never discussed PrEP or received information about it in health-care settings, even though the majority had recently been screened for HIV or sexually transmitted infections. Participants generally felt PrEP was not relevant to them because they perceived themselves at low risk for HIV, thinking PrEP would be indicated for people who have high numbers of sex partners or partners with HIV. Some participants said they would view a potential partner using PrEP positively (e.g., as responsible), while others raised concerns (e.g., about their presumed behaviors). Concerns with side effects and long-term drug toxicity were common, and a few participants expressed anti-medication beliefs. Although awareness seems high, PrEP appears to not have yet entered the repertoire of HIV prevention options for heterosexually active New Yorkers. PrEP promotion among this population could benefit from: messaging targeted to heterosexual adults; ensuring health-care providers inform all sexually active patients about PrEP; and clarifying for practitioners and the public that PrEP is an option for any sexually active person, even those who do not report substantial HIV risk.