The Relationship Between Polysubstance Injection Drug Use, HIV Risk Behaviors, and Interest in Pre-Exposure Prophylaxis (PrEP) Among People Who Inject Drugs in Rural West Virginia.

OBJECTIVE

The opioid crisis has increased risks for injection drug use (IDU)-associated HIV outbreaks throughout the United States. Polysubstance use and syringe sharing are common among rural people who inject drugs (PWID). However, little is known about how polysubstance IDU affects engagement in HIV prevention efforts among non-urban PWID. This study assesses the associations between profiles of polysubstance injection, injection-related HIV risk, acquiring syringes from a syringe services program (SSP), HIV testing, and pre-exposure prophylaxis (PrEP) awareness and interest among PWID in rural Appalachia.

METHOD: We used survey data from 392 respondents in Cabell County, West Virginia who had injected drugs in the past 6 months. We conducted a latent class analysis using seven measures of IDU and tested for associations with injection-related HIV risk, receiving syringes from an SSP, having been tested for HIV, and PrEP awareness and interest.

RESULTS

We identified three classes of polysubstance IDU in our sample: polysubstance use, heroin and crystal methamphetamine use, and crystal methamphetamine and buprenorphine/suboxone use. The polysubstance use class had the highest injection-related HIV risk (81.8% at risk), high syringe acquisition at an SSP (67.7%), and highest rate of HIV testing (60.0%). PrEP awareness was low across the sample (30.0%), but most PWID expressed interest in using PrEP (57.7%).

CONCLUSIONS

Patterns of polysubstance IDU have unique relationships with key HIV risk factors and protective behaviors. The expansion of harm reduction services in rural settings is warranted to prevent incident HIV infections.