Cohort III
2019 - 2021

Valeria Cantos | Souhail Malavé-Rivera | John Sauceda | Leah Varga


Souhail Malave-Rivera

Souhail M. Malavé-Rivera, PhD
University of Puerto Rico

CFAR Mentor:
Anandi Sheth, MD
   (Emory CFAR)

Collaborating Partner:
Vivian Tamayo, MD
   (Puerto Rico CoNCRA)

A CBPR Approach to Assess Knowledge, Willingness and Intention to use PrEP Among Hispanic/Latina Women at Increased Risk for HIV Infection in Puerto Rico

In the U.S., women represent 20% of the HIV infections and 1 in 9 are not aware of their infection. Hispanic/Latinas are three times more likely be diagnosed with HIV when compared with non-Latina white women. The current national response to end the HIV epidemic focuses on high-prevalent areas and populations. Localized efforts seek to improve outcomes among those most affected by the epidemic, including Hispanic/Latinxs in Puerto Rico (PR). PR has one of the highest HIV rates with a 13.3 diagnosis rate; especially in the San Juan region. By the end of March 2019, 49,519 persons have been diagnosed with HIV and AIDS in PR. Women account for 25% of all adolescent and adult cases. Thus, the need to consider Pre-exposure prophylaxis (PrEP) as an option for women. Healthcare providers should be informed to better educate potential PrEP users.

When used as prescribed, PrEP can reduce HIV transmission (>90%) in men and women. Yet, most implementation efforts have focused in men who have sex with men (MSM). In PR, evidence of PrEP use among MSM is newly available. Results from an implementation study at a local clinic indicate that among MSM knowledge and information from providers is limited, there is low uptake but high acceptability of PrEP. This scenario might be similar among women at increased risk for HIV in PR, yet there is no evidence available with this group. Moreover, PrEP studies tailored to Hispanic/Latina women in the U.S. are scarce.

Thus, consistent with ADELANTE's and the National Plan to End HIV in America's priorities to end the HIV epidemic, we propose an exploratory mixed-methods study using a community-based participatory research (CBPR) approach to: 1. Assess the knowledge, willingness and intention to use PrEP among women at increased risk in PR. In collaboration with community key informants we will adapt an existing culturally-sensitive survey and administer it to 75 women at increased risk for HIV, and 2. Describe and explain the role of multi-level factors that influence the PrEP knowledge, willingness and intention to use PrEP among women at increased risk for HIV in PR.

We will conduct 12 in-depth qualitative interviews with HIV-negative women at increased risk for HIV infection and 21 healthcare professionals who provide sexual, preventive and reproductive services to women. Data will expand on findings from Aim 1, explaining contextual factors that influence the level of knowledge, willingness and intention to use PrEP among women at increased risk for HIV. The main goal of the proposed formative research is to inform future studies and interventions to optimize awareness and uptake among women from the most affected areas and further the end of the HIV epidemic.