The introduction of PrEP (Pre-Exposure Prophylaxis) in recent years provides a new alternative to prevent new HIV infections. When taken consistently, PrEP can reduce the risk of HIV up to 92%. However, there is lack of knowledge about this treatment both from community members and service providers who serve them. PrEParándonos aims to fill this gap by educating service providers who can later develop strategies to reach those individuals who might benefit and desire PrEP.

The overall objective of PrEParándonos is to enhance/strengthen the capacity of community-based organizations (CBOs) to integrate and implement PrEP. This is accomplished by exploring, assesing, and understanding the challenges experienced by organizations and communities under acceptibility, accessibility, availability, adherence and awareness.

At the completion of PrEParándonos, attendees will be able to:

• Understand the research that informs the effectiveness of PrEP.
• Learn how to develop opportunities for PrEP community awareness and education
• Conduct self-organizational/programmatic/community assessment aiming at assessing accessibility, availability, and acceptability around PrEP implementation
• Understand the process of transforming findings into action items to address PrEP implementation
• Sustain relationships for ongoing on-site technical assistance

AVAILABILITY: Ensuring adequate clinical capacity and delivery of PrEP is essential to its uptake and adherence

It is unknown how available PrEP is in many communities. Some healthcare providers, health departments and AIDS service organizations have begun compiling lists of PrEP providers for their clients. While most of the providers identified thus far are located in more urban areas, the availability of PrEP in more rural and suburban areas is still unknown.

ACCESSIBILITY: The degree to which PrEP is obtainable to as many people that are eligible considering the cost and proximity to resources

On both ends of the patient-provider relationship, a lack of accessible information and services impede PrEP uptake and prescription by both patients and providers. This lack of accessibility seems to be a large part of the reason behind PrEP’s slow take-off within many groups in need. It is crucial to engage with those populations who could benefit most from PrEP. In regards to healthcare providers, one of the greatest barriers to providers prescribing PrEP is a lack of knowledge on the existing PrEP research.

ACCEPTABILITY: Acceptance and motivation to see PrEP as a tool to prevent HIV infection, from both medical providers and community members

In order for an intervention such as PrEP to be successful, it must first be deemed acceptable as a means of prevention to both community members and service providers. In the case of community members, there is some evidence of its acceptability. In a racially/ethnically diverse sample of men who have sex with men (MSM) in Boston, 74% reported being more willing to use PrEP after being educated about its potential for preventing HIV infection. Of those who reported being willing to use PrEP, 78% of non-whites were likely to intend to use PrEP. Patients also report that doctors appear judgmental about their decision to get on PrEP and are unwilling to prescribe it.

ADHERENCE: Emphasizing the consistency in using PrEP to be an effective HIV prevention tool

Studies established correlations between HIV-related stigma and avoidance of testing, selective disclosure in situations where there may be negative consequences, and suboptimal adherence to drug treatment. This same stigma can be detrimental to PrEP’s acceptability. This guilt and lack of social support from key figures can affect PrEP uptake and adherence; adherence in particular is a key issue, as inconsistent use of PrEP decreases its effectiveness in HIV prevention.

AWARENESS: Disseminating the information so providers will recommend and community members will ask for PrEP

Prior knowledge of the drug appears to be one factor related to its uptake. PrEP awareness varies throughout many cities, as low as 19% in some places while only as high as 63% in others. Over 78% of providers in a New England study said a lack of awareness of PrEP was a barrier to prescribing it. In a PrEP readiness survey distributed by the Commission at the 2014 U.S. Conference on AIDS, only 68% of 69 respondents knew that PrEP was taken before exposure to the HIV virus. This result highlights the lack of knowledge and misinformation that exists regarding PrEP. A phenomenon of silence exists between healthcare providers and their patients regarding HIV risk. Research shows that many healthcare providers do not bring up HIV risk with their patients, and many individuals are reluctant to bring up risk behaviors with their providers. Because they are in a position to effect behavior change, nurse practitioners, physician assistants, and doctors have the opportunity to disseminate information on PrEP and recommend it to those who are eligible for it.