Pre-exposure Prophylaxis Awareness and Use Among Cisgender Women at a Sexually Transmitted Disease Clinic

Background: Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV transmission. Cisgender women (cis-women) constitute only a small proportion of PrEP users in the United States despite accounting for 19% of new HIV infections in 2016. Setting: The Rhode Island Sexually Transmitted Diseases (STD) Clinic from 2013 to 2016. Methods: We report on the demographic and behavioral characteristics of all HIV-negative, cis-women who presented to the Clinic and of those who met Centers for Disease Control and Prevention (CDC) indications for PrEP. In a logistic regression analysis, we evaluated PrEP awareness among cis-women by year and demographic characteristics. We compared PrEP awareness among ciswomen with PrEP awareness among cisgender men who have sex with men and among cisgender men who inject drugs presenting to the Clinic. Results: Among 1431 HIV-negative cis-women, 84 (5.8%) met CDC indications for PrEP. PrEP awareness was significantly lower among Hispanic/Latina cis-women [11.0%; adjusted odds ratio (AOR): 0.46, 95% confidence interval (CI): 0.31 to 0.66] and nonHispanic black cis-women (13.8%; AOR: 0.59, 95% CI: 0.39 to 0.89) relative to non-Hispanic white cis-women (20.7%). Men who have sex with men had significantly greater PrEP awareness (60.3%; AOR: 5.85, 95% CI: 3.35 to 10.23) than cis-women (22.9%). Only one woman reported PrEP use. Conclusions: Two-thirds of HIV-negative cis-women presenting for HIV/sexually transmitted disease testing and meeting CDC indications for PrEP were unaware of PrEP, and only one woman reported ever using PrEP. There is a critical need for public health professionals and health care providers to increase PrEP awareness and use among cis-women at risk for HIV.