A Dyadic Analysis of PrEP-Related Interpersonal Communication among Women who Inject Drugs in Philadelphia
Authors:   , Felsher Marisa A. , Roth Alexis M. 
Published: April 2022

Women who inject drugs (WWID) remain a population at risk for HIV infection. Pre-exposure prophylaxis (PrEP) is a user-controlled biomedical HIV prevention tool that could decrease HIV risk among WWID. However, PrEP uptake among WWID is low, which can be attributed in part to low awareness. Interventions that incorporate interpersonal communication between WWID and their network members could play an important role in the diffusion of PrEP information. However, little is known about who WWID would be willing to diffuse PrEP information to in the context of a peer intervention, nor characteristics of relationships that motivate willingness to share information. The objective of this dissertation is to identify how characteristics of relationships impact interpersonal communication about PrEP between WWID and members of their social network. This dissertation used a sequential mixed-methods exploratory design. In Phase 1 (aim 1) in-depth interviews were conducted with 20 WWID to explore the context and content of previous communication about PrEP with network members. In phase 2 (aims 2 and 3), a quantitative social network survey was administered to 40 WWID and elicited information about 375 social network members in order to identify factors associated with willingness to share information about PrEP within dyads in the context of a peer intervention. Findings from each of these studies were compared and contrasted through triangulation to identify key themes and areas for future research and practice. Aim 1 findings demonstrate that WWID initiated PrEP-related conversations with over half of network members elicited. Reasons included to educate other WWID perceived to be at risk for HIV about PrEP, to receive social support from peers with whom they are emotionally close, and to disclose PrEP use to control the narrative of why they take PrEP. Findings from aim 2 show that WWID were willing to share PrEP information with 83% (m=312) of network members in the context of a peer intervention. In a multivariable model, participants had higher odds of willingness to share PrEP information within relationships where the network member was female, homeless, and perceived by respondent to be at risk for HIV. Aim 3 results show that constructs related to the Theory of Planned Behavior (attitudes, subjective norms, and perceived behavior control of sharing information about PrEP) vary between relationships and are significantly associated with willingness to share PrEP information. This dissertation highlights that WWID have previously shared PrEP information with network members and are also willing to share PrEP information with most network members in the context of an intervention. Characteristics of relationships, as well as constructs of TPB operating within dyads, impact WWID's willingness to share information with network members. Formatting TPB be used within ego-centric social network analysis expands the utility of TPB to encompass interpersonal processes and has application to predicting intention to engage in other dyadic behaviors. Peer interventions where WWID share PrEP information with network members may be a feasible approach to increasing PrEP awareness among highly vulnerable populations.