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J Acquir Immune Defic Syndr. 2018 Dec 12. doi: 10.1097/QAI.0000000000001935. [Epub ahead of print]

Social networks and its impact on women's awareness, interest, and uptake of HIV pre-exposure prophylaxis (PrEP): Implications for women experiencing intimate partner violence.

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Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92093.
Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06520.
Department of Psychology, George Washington University, 2125 G Street NW, Washington, DC 20052.
Department of Community-Public Health Nursing, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Rm 456, Baltimore, MD 21213.



In the U.S., women represent less than 5% of all pre-exposure prophylaxis (PrEP) users. Social networks may promote and/or inhibit women's PrEP awareness, which could influence PrEP intentions. Further, women experiencing intimate partner violence (IPV) may have smaller, less supportive networks, which could deter or have no impact on PrEP care engagement. This study examined associations between network characteristics and women's PrEP awareness, interest, uptake, and perceived candidacy; and analyzed IPV as an effect modifier.Setting/Methods: From 2017 to 2018, data were collected from a prospective cohort study of 218 PrEP-eligible women with (n=94) and without (n=124) IPV experiences in Connecticut. Women completed surveys on demographics, IPV, social networks, and PrEP care continuum outcomes.


Adjusted analyses showed that PrEP awareness related to having more PrEP-aware alters. PrEP intentions related to having more alters with favorable opinions of women's potential PrEP use and a smaller network size. Viewing oneself as an appropriate PrEP candidate related to having more PrEP-aware alters and more alters with favorable opinions of women's potential PrEP use. IPV modified associations between network characteristics and PrEP care. Having members who were aware of and/or used PrEP was positively associated with PrEP care engagement for women without IPV experiences, but had either no effect or the opposite effect for women experiencing IPV.


Improving PrEP attitudes might improve its utilization among women. Social network interventions might be one way to increase PrEP uptake among many U.S. women, but may not be as effective for women experiencing IPV.

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