Adolescent and young adult (AYA) women report some of the highest rates of intimate partner violence (IPV) and HIV exposure. Intimate partner violence (IPV) experiences increase HIV infection rates four-fold. AYA women experiencing IPV have reported having sex with a partner of unknown HIV status, limited condom use and repeated sexually transmitted infections (STI) diagnoses or exposures. Although recently approved for use among AYA, Tenofovir/Emtricitibine, is underutilized among AYA populations as pre-exposure prophylaxis (PrEP); particularly among women exposed to IPV. Little is known about how AYA-serving providers address these heightened HIV risks or how they discuss PrEP as a prevention option. This study explored providers’ communication with AYA women about IPV and PrEP.
We used convenience sampling to recruit health and social service providers (N=22) across three sectors serving AYA women: IPV service providers (IPVSP; n=9), reproductive healthcare providers (RHP; n=7) and PrEP healthcare providers (PHP; n=6). Semi-structured interviews were conducted using tailored guides to explore providers’ IPV and HIV screening practices, PrEP knowledge and attitudes, and trauma-informed care strategies. Interviews were audio-recorded and transcribed verbatim. A codebook was derived from interview guide categories. Two team members independently coded transcripts and data were managed in Dedoose® qualitative analysis software. Coding discrepancies were reconciled with a third team member. We identified themes using an inductive thematic analysis approach.
A majority of respondents were female (91%, n=20). IPVSP reported the highest mean number of years at their organization (8 years) and experience in their field (19 years). A majority (85%) of RHP and IPVSP lacked PrEP knowledge and/or awareness. No providers reported educating IPV-exposed AYA women about PrEP or referring them for PrEP services. Two primary themes emerged as strategies for communicating with AYA women about IPV and PrEP. Theme 1:“Finding a ‘Good Candidate’” described providers’ methods of screening for IPV and determining PrEP eligibility. While providers gave comprehensive definitions of IPV, they reported non-systematic IPV screening methods such as observing behavioral cues rather than utilizing standardized assessment tools. Providers reported adherence to CDC guidelines for PrEP use among heterosexual women but their interpretations of the guidelines excluded IPV experiences as suggestive of heightened HIV risk. Theme 2: “Selling It” characterized providers’ hypothetical use of trauma informed approaches to concurrently address IPV and PrEP including strategies for risk reduction counseling. Most providers felt responsible to provide integrated education about IPV and HIV prevention strategies as well as promote PrEP.
PrEP was not consistently promoted in practice but the utility of its use with this population was recognized universally among health and service providers. While some findings align with previous research, results suggest providers are missing opportunities to increase awareness among this group of AYA women. PrEP eligibility guidelines should address enhanced risks for HIV exposure among AYA women experiencing IPV. Future research may explore provider-specific trainings in order to optimize communication approaches that address the intersection of PrEP and IPV across service and healthcare system sectors.
Sources of Support
Eunice Kennedy Shriver National Institute of Child Health and Human Development, John Hopkins Population Center
© 2018 Published by Elsevier Inc.