Date of Award

January 2018

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jaimie P. Meyer

Abstract

ELIGIBILITY FOR PRE-EXPOSURE PROPHYLAXIS IN WOMEN INVOLVED IN THE CRIMINAL JUSTICE SYSTEM

Ronnye Rutledge, Jaimie P Meyer. Section of Infectious Disease, Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT

Background: Women involved in the criminal justice system (WICJ) are at high risk of acquiring HIV and would benefit from HIV pre-exposure prophylaxis (PrEP) but there are no studies in this population to inform PrEP implementation programs.

Methods: We conducted a cross-sectional survey of HIV-uninfected, cis-gender women on probation, parole and/or recently released from prison/jail to assess PrEP awareness, eligibility, and potential barriers to uptake as well as factors included in the PrEP continuum of care.

Results: The 125 HIV-uninfected WICJ surveyed reported high HIV risk behaviors including recent transactional sex (22.4%) and unsafe injection practices (14.4%). Despite 33% (n=42) meeting eligibility criteria for PrEP, only 25% were aware of PrEP and one person was currently using it. Only 16.7% of those who were PrEP eligible perceived they were at risk for HIV. Following a brief explanation of PrEP, 90% said they would try it if recommended by their physician. Compared to those not PrEP eligible (n=83), PrEP eligible women were less likely to be stably housed or have a primary care provider, and were more likely to be violence-exposed, charged with drug possession, have lifetime substance use, or be living with Hepatitis C infection.

Conclusion: WICJ engage in HIV risk behaviors at high rates that make them eligible for PrEP. Uptake is partially limited by lack of PrEP awareness or underestimation of personal HIV risk. WICJ report receptiveness to PrEP and represent an important population for targeted PrEP implementation programs.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/25/2100

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