PrEP access and utilization among women with a history of injection drug use in Minneapolis, Minnesota

Abstract Background In the setting of an ongoing HIV outbreak among people who inject drugs (PWID) in Minneapolis, HIV pre-exposure prophylaxis (PrEP) uptake remains low, particularly among women. Prior work in large urban centers in the northeastern United States has linked low PrEP use to limited PrEP education and misperceptions of HIV risk, but little is known about these factors among women who inject drugs (WWID) in Minneapolis. Methods Between November 2023 and January 2024, we conducted a cross-sectional survey of 30 WWID in Minneapolis. Participants were eligible if they were ≥18 years, identified as a woman, had a lifetime history of injection drug use, and self-reported negative or unknown HIV status. Surveys were completed independently or with assistance from study staff and gathered data on demographics, medical care experiences, barriers to daily medication adherence, drug use characteristics, sexual behaviors, and STI history. Study-defined PrEP suitability was based on a lifetime history of bacterial STIs, sharing needles or other injection works in the previous six months, having sex with a partner of unknown HIV status during the previous six months and not using a condom during the participant’s most recent sexual encounter, or engaging in transactional sex in the previous six months. Descriptive statistics were calculated to describe the population, including interest in and experience with PrEP. Results Thirty cisgender women with a lifetime history of injection drug use completed the survey, 77% of whom met study-defined criteria for PrEP suitability. Among participants, 87% had never taken PrEP, and 43% had never heard of PrEP. After learning about PrEP, 43% of participants were somewhat or very interested in taking it. Conclusion In this study, PrEP use and awareness were limited despite a high prevalence of study-defined PrEP suitability. A substantial subset of participants expressed interest in or willingness to use PrEP, while others reported little or no interest. These findings support the need for improved communication about HIV risks, PrEP options, and to develop women-centered approaches to HIV prevention.