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PLoS One. 2018 Dec 7;13(12):e0205593. doi: 10.1371/journal.pone.0205593. eCollection 2018.

Knowledge, interest, and anticipated barriers of pre-exposure prophylaxis uptake and adherence among gay, bisexual, and men who have sex with men who are incarcerated.

Author information

1
Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America.
2
Center for Health Equity Research, University of North Carolina, Chapel Hill, North Carolina, United States of America.
3
Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, Rhode Island, United States of America.
4
Department of Psychology, Jackson State University, Jackson, Missouri, United States of America.
5
Rhode Island Hospital, Providence, Rhode Island, United States of America.
6
Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America.
7
Department of Medicine, Brown University, Providence, Rhode Island, United States of America.
8
Center for AIDS Research, University of North Carolina, Chapel Hill, North Carolina, United States of America.
9
College of Health and Human Services, University of North Carolina, Charlotte, North Carolina, United States of America.

Abstract

Criminal justice (CJ) settings disproportionately include populations at high risk for acquiring HIV, and CJ-involved individuals are often at the intersection of multiple overlapping risk factors. However, few studies have examined attitudes about pre-exposure prophylaxis (PrEP) among incarcerated men who have sex with men (MSM). This study explored interest in, knowledge of, and barriers to PrEP uptake among gay, bisexual, and other men who have sex with men at the Rhode Island Department of Corrections. Using semi-structured interviews, 26 MSM were interviewed about PrEP knowledge, interest, timing preferences for provision (e.g. before or after release), and barriers to uptake and adherence during community re-entry. Interviews were coded and analyzed using a general inductive approach. Participants demonstrated low initial knowledge of PrEP but high interest after being told more about it. Participants self-identified risk factors for HIV acquisition, including condomless sex and substance use. In addition, participants preferred provision of PrEP prior to release. Post-release barriers to PrEP uptake and adherence included 1) concerns about costs of PrEP medications; 2) anticipated partner or family disapproval; 3) lack of access to transportation; 4) unstable housing; 5) compounding impacts of multiple hardships leading to a de-prioritization of PrEP and 6) fears of future re-incarceration. These results point to the need for future PrEP interventions among incarcerated populations that address incarceration and PrEP related barriers during community re-entry via wraparound services that address PrEP and incarceration-related barriers.

Conflict of interest statement

The authors have declared that no competing interests exist.

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