PrEP Prior Knowledge, Acceptability, and Intervention Strategies in a County Jail

background: Individuals involved with the criminal justice (CJ) system have a disproportionate burden of HIV infection and/or are at increased risk for contracting HIV due to a high prevalence of HIV related behavioral risk factors, e.g. substance use, transactional sex, same sex behavior, etc. HIV Pre-exposure prophylaxis (PrEP)has been shown to be effective in reducing HIV acquisition among high-risk individuals. However, PrEP has not been widely utilized among CJ populations as an effective HIV preventative measure.

methods: This study was conducted among detainees within Arkansas’s largest county jail. Detainees were screened using CDC guidelines on clinical indication for PrEP. 21 semi-structured in-depth interviews were conducted among jail detainees. Interviews asked about prior knowledge of HIV and PrEP, interest/willingness in using PrEP, preferred timing of intervention, screening practices for high-risk individuals, and barriers/facilitators to PrEP uptake upon release.

results: Five major themes emerged: 1) accessing healthcare upon release was not a high priority; 2) perceived risk of HIV was low; 3) participants felt ambivalent about disclosing their HIV risk behaviors in CJ settings; 4) participants had limited prior knowledge of PrEP but expressed willingness for uptake; 5) participants enumerated facilitators/barriers to PrEP uptake upon release and within the community.

conclusions: County jails represent a potentially important setting to implement HIV prevention interventions, including PrEP. This population is one that is interested in utilizing PrEP if it is accessible and barriers to uptake are addressed. Future developments of CJ interventions should consider these themes in order to maximize success for PrEP.