Perceptions and Attitudes toward Pre-Exposure Prophylaxis Among Drug-Using Street-Involved Youth In a Canadian Setting

Background: Young people who use drugs have an elevated risk of HIV transmission, and represent a key population for HIV prevention efforts. Pre-exposure pro- phylaxis (PrEP) – a biomedical prevention tool involving daily medication to prevent the transmission of HIV – has been advanced as strategy for lowering HIV transmission among such key populations, and yet understand of drug- using young people’s views toward this prevention tool are poorly documented. This study examines perceptions and attitudes toward pre-exposure prophylaxis (PrEP) for HIV infection among drug-using street-involved youth in Vancouver.
Methods: We conducted qualitative interviews with twenty-five participants, aged 17-24, recruited from an on- going prospective cohort study comprised of drug-using
street-involved youth. We analyzed interview transcripts thematically, focusing on perceptions and attitudes toward PrEP, knowledge regarding HIV transmission, and the iden- tification of perceived high-risk practices and populations.
Results: Street-involved youth expressed ambivalent toward PrEP, particularly young men. Among participants, ambivalence toward PrEP primarily stemmed from their perception that they were not ‘at risk’ of HIV transmis-
sion and that HIV risks were context-dependent (e.g., low syringe availability). There was a misperception regarding pathways for HIV transmission (e.g., salivary transmission, skin contact transmission). Even though participants re- ported engagement in HIV risk behaviors (e.g., condomless sex, syringe-sharing) in contexts that undermined drug and sexual risk reduction, they believed that they had low risk for HIV acquisition. Participants commonly referred to themselves and peers as `clean’ in comparison to `dirty’ in- dividuals (e.g., people who were homeless) and commonly reported that they were able to visually identify individuals with HIV based on physical appearance and hygiene.
Conclusion: There remains a need for HIV-related educa- tional programming (including PrEP) among drug-using street-involved youth to address HIV risks and increase the potential uptake of PrEP. However, addressing contextual forces driving HIV risks will also remain necessary.