PrEP Awareness, Interest, and Use among Women Who Inject Drugs in Seattle, Washington: A Mixed Methods Study

Women who inject drugs (WWID) are disproportionately affected by HIV and experience multiple barriers to PrEP use. We conducted a mixed methods study to assess PrEP awareness, interest, and use, and determinants of PrEP utilization among WWID at three community sites in Seattle, Washington from March-May 2023. Participants were ≥ 18 years old, spoke English, identified as women, had a history of injecting drugs, and self-reported a negative or unknown HIV status. We describe survey participant characteristics (n = 30) by PrEP candidacy based on behaviors associated with HIV acquisition. We concurrently recruited 16 WWID for semi-structured interviews, which were analyzed using the Rapid Assessment Process. Survey and interview data were triangulated to enhance interpretations. Among 30 WWID, 25 (83%) were PrEP candidates, of whom 19 (76%) had heard about PrEP; only 2 (8%) were currently using PrEP. Among PrEP candidates, 13 (57%) reported interest in daily oral PrEP and almost half (n = 12, 48%) reported interest in injectable PrEP. Qualitative data revealed cursory PrEP knowledge and a strong interest in daily oral and injectable PrEP among those who perceived they were at risk for HIV. Several barriers to PrEP use were noted including housing instability, adherence challenges, limited perceived risk, and competing priorities like safety and substance use. While most WWID were aware of PrEP, qualitative data suggested significant misconceptions about PrEP, and many described complex, intersecting barriers to use. Our findings highlight the need for increased low-barrier, population-specific interventions to improve uptake and sustained use of PrEP among WWID.