Exploring PrEP Motivation as a Modifiable Target for HIV Prevention Uptake for Cisgender Women in Atlanta, Georgia.

Background: Pre-exposure prophylaxis for HIV prevention (PrEP) prescriptions in the U.S. have increased, yet only 15% of individuals assigned female at birth who could benefit from PrEP had received prescriptions as of 2022, with marked racial disparities.

Setting: Georgia has the highest HIV incidence of any U.S. state, with over half of new cases occurring in Atlanta. Accounting for approximately 1-in-5 cases, cisgender women living in Atlanta may benefit from clinic-based efforts to increase PrEP uptake.

Methods: We enrolled 102 women from PrEP-providing family planning clinics in the Atlanta metro area. After clinic visit, women self-completed a questionnaire and a staff-administered questionnaire. Surveys were repeated at 3- and 6-months; using baseline data only, we conducted bivariate analyses to determine factors associated with willingness to use PrEP.

Results: Participants were primarily Black (87.5%) and aged >24 (54.5%). Women considered their risk of next-year HIV diagnosis (70%) and HIV risk (85.8%) to be low, despite 45% endorsing perception of at least slightly risky sexual behavior. Most women (59.4%) were willing to take PrEP, though few were planning or had started to take PrEP. Lifetime gonorrhea or trichomonas diagnosis, perceived sexual risk, perceived high/moderate HIV risk, and more positive PrEP attitudes scores were associated with PrEP willingness, as were individual PrEP attitudes, concerns/barriers, and stigma items.

Conclusion: Findings suggest modifiable constructs that could be used by providers as interventional targets with patients to increase PrEP uptake. We provide suggestions mapped onto the Stages of Change Model and PrEP Care and Motivation continua.