Kamila A. Alexander, PhD, MPH, RN Helena A. Addison, BA Breanna N. - PowerPoint PPT Presentation

Kamila A. Alexander, PhD, MPH, RN Helena A. Addison, BA Breanna N. Beard, BA Johns Hopkins School of Nursing PrEP for Women Conference September 25, 2018

BACK CKGR GROUND OUND 1 in 3 women CDC, 2017; NISVS, 2015; Interagency Federal Working Group Report, 2013

Intimate P Intima te Par artner tner V Violence (I iolence (IPV) PV) and and Repr eproductiv oductive e Coer Coercion cion (R (RC) C) – Health disparities disproportionately affect Black, Latina, and low-income women – Increase risks for HIV (and unintended pregnancies) 4x • Condom negotiation higher • STI diagnoses/exposures • Partner HIV status unknown risk of HIV – Women in abusive relationships express interest in risk reduction and prevention options – Need to determine safest ways to deliver PrEP (and contraceptives) to this population Campbell, Lucea, Stockman & Draughon, 2012; Willie, et al, 2017; Garfinkel, et al, 2017

FRA FRACTURE CTURED D SY SYST STEM EMS • Barriers to healthcare IPV screening and counseling CDC guidelines for PrEP – Time use among women – Poor or non-existent policies apply to a majority of – Limited incentives for screening women experiencing – Discomfort IPV. – Inadequate cross-sector collaborations with survivor advocate services Colarossi et al, 2010; Jaffee et al, 2005; Yonaka, et al, 2007; Cha, et al, 2014; Tower, et al, 2006; Weeks, et al, 2008; Minsky-Kelly, et al., 2005. O’Campo , et al, 2011; Frankel, 2007.

MULTI-SECTOR COLLABORATIONS PrEP Women’s Providers Health Providers IPV Service Providers Multi-sector Collaboration to increase Contraceptive use and PrEP uptake among IPV-exposed women

TW TWO-PHASE STUD PHASE STUDY Phase 1 : Interviews & surveys with service providers from multiple health sectors – Reproductive health providers – PrEP providers – IPV service providers Phase 2: Survey of 100 women exposed to IPV and RC

PrEP Study Objective To understand the factors related to LARC LARC and PrEP acceptability among IPV IPV-exposed women

METHODS • Convenience sample – Women who have experienced a form of IPV within 12 months (Recruitment Goal: N = 100) – Recruitment at domestic violence service centers, youth development centers, beauty salons, etc. in the Baltimore area • Quantitative survey • Preliminary analysis procedure – Descriptive statistics

PRE PRELIMIN LIMINAR ARY Y FINDING FINDINGS: S: PrE PrEP KNOWLEDG WLEDGE Yes 33% No 67%

LOCA CATIO TION FOR FOR OBT BTAIN AININ ING PrE PrEP WHERE WOULD IPV-EXPOSED WOMEN PREFER TO GET PrEP? 0 2 4 6 8 10 12 GENERAL COMMUNITY HEALTH CARE CENTER, VAN, OR CLINIC HOSPITAL REPRODUCTIVE HEALTH CARE CENTER (EX. PLANNED PARENTHOOD) PRIVATE MEDICAL PRACTICE HIV CLINIC DOMESTIC VIOLENCE ORGANIZATION

ROLE OLE OF PE OF PERSON RSON PR PROVID VIDIN ING G PrE PrEP WHO WOULD IPV-EXPOSED WOMEN PREFER TO GET PrEP FROM? 30 25 20 15 10 5 0 PRIMARY CARE REPRODUCTIVE HIV/INFECTIOUS DOMESTIC VIOLENCE PROVIDER HEALTH PROVIDER DISEASE SPECIALIST ADVOCATE (EX. OB/GYN)

Pr Preliminar eliminary y Find Findings ings WHO SHOULD MEDICAL PROVIDER TELL ABOUT PrEP? All patients should be told 15% about PrEP Only high-risk patients should 22% be told about PrEP 63% No patients should be told about PrEP

Pr Prelimi elimina nary y Find Findings ings: Provide Pr vider I r Inte nterac actions tions WHO SHOULD START THE PrEP CONVERSATION? WOMAN of women of women 24% NO would be more would be PREFEREN PROVIDER CE likely to take embarrassed 17% 59% PrEP if a health to ask their care provider doctor to recommended give them it. PrEP

PRELIMI PREL IMINAR ARY Y FIND FINDIN INGS GS ROLE OF DOMESTIC VIOLENCE ADVOCATES Would be more likely to take PrEP if a domestic violence advocate recommended the pill. Would be embarrassed to ask a domestic violence advocate for PrEP

PREL PRELIMI IMINAR ARY Y FIND FINDIN INGS: GS: PAR ARTNER B TNER BEHA EHAVIO VIOR Partner Controlled PrEP Use

PRE PRELIMIN LIMINAR ARY Y FINDING FINDINGS: S: PAR ARTNER TNER REA REACTIO CTIONS VERBAL ABUSE RISK “ WILL YOUR PARTNER TELL YOU NOT TO TAKE PrEP ?” 21% 79% Yes PHYSICAL ABUSE RISK No 23% 77% 7% 93%

PREL PRELIMI IMINAR ARY Y FIND FINDIN INGS: GS: PAR ARTNER R TNER REA EACTIO CTIONS NS 85% 90% No No 15% 10% YES YES PARTNER WOULD HAVE SEX PARTNER WOULD THREATEN TO WITH SOMEONE ELSE LEAVE

PREL PRELIMI IMINAR ARY Y FIND FINDIN INGS: GS: PrEP PrEP SABO SABOTAGE GE

ONGOING DATA ONGOING A COLLE CO LLECTION CTION What We Need From You 1) Participate (if eligible) Interviews – 1 hour Surveys – 15 minutes Location & time that fits Complete one today! your schedule http://bit.ly/prepforproviders $10 gift card as thank you $5 gift card as thank you 2) Provide your contact information if you would like to learn more about participation 3) Refer women in your care who may be interested in participating

Leading the way in education, research and practice – locally and globally.