PrEP attitudes, willingness, and preferences among men incarcerated in jail in Massachusetts

People who inject drugs (PWID) are both disproportionately incarcerated and affected by HIV infection. Systemic inequities perpetuate the cyclic nature of injection drug use (IDU) and incarceration, and both IDU and incarceration are linked to higher rates of HIV infection. Pre-exposure prophylaxis (PrEP) is highly effective in HIV prevention and is currently available as a daily oral pill. Longer-acting PrEP options, such as injectables and implants, are also in development to improve accessibility and adherence. Despite these advancements, PrEP uptake remains low among PWID and individuals recently released from jail, and there is limited literature exploring the preferences for PrEP uptake within this population. We conducted qualitative interviews using a semi-structured interview guide with 20 male participants (19 incarcerated in a Massachusetts jail and 1 recently released) to assess perceived HIV risk, knowledge of PrEP, barriers to PrEP uptake, and preferences for PrEP modality and frequency. The data were analyzed using a directed content analysis approach. Most participants were aware of their HIV risk but were largely unaware of PrEP and had never been educated about PrEP by a healthcare provider. Participants cited a lack of access to healthcare, stigma around HIV infection, and feasibility as barriers to uptake. While participants expressed interest in longer-acting PrEP, most preferred the oral pill due to distrust of the safety and efficacy of injectables and implants, countering the assumption that modality changes alone can improve low PrEP uptake. Our findings underscore the urgent need for targeted education and interventions to improve HIV prevention in vulnerable populations impacted by incarceration. While long-acting injectables have been touted to help address barriers to accessing healthcare among this population, skepticism about the efficacy of long-acting injectables among this population may prevent these efforts. It is important to further research the willingness to uptake PrEP and modality preferences among this population to meet their needs.