Considerations of HIV PrEP Among Heterosexually Active Women and Men: Results from a Qualitative Study in New York City.

Although 22% of new HIV diagnoses in the USA are attributed to heterosexual contact, uptake of pre-exposure prophylaxis (PrEP) remains low among heterosexually active individuals and information about PrEP considerations in this population is limited. We report on a cross-sectional qualitative study exploring attitudes toward PrEP among a diverse sample of 50 heterosexually active cisgender adults (31 women, 19 men) in New York City. Approximately, two-thirds (34) had previously heard of PrEP, but none had used it. Many learned about PrEP through marketing and social interactions, leading them to perceive it as primarily intended for gay or bisexual men and transgender individuals. Most had never discussed PrEP or received information about it in healthcare settings, despite recent HIV screenings. Participants generally viewed PrEP as irrelevant because they perceived themselves at low risk for HIV, considering it appropriate only for people with many sex partners or partners with HIV. Some said they would view a potential partner using PrEP positively (e.g., as responsible), while others expressed concerns about their presumed behaviors. Concerns about side effects and long-term drug toxicity were common and a few participants expressed anti-medication beliefs. While awareness appears high, heterosexually active New Yorkers do not seem to have started to think of PrEP as one of their HIV prevention options. PrEP promotion for this population could benefit from: messaging targeted to heterosexual adults; ensuring health-care providers inform all sexually active patients about PrEP; and clarifying for practitioners and the public that PrEP is an option for any sexually active person, regardless of self-reported HIV risk.