Intersecting Stigma: Rural America, HIV PrEP, and Injection Drug Use


Suzan Walters, PhD, discusses her research on the PrEP care continuum among people who inject drugs in rural versus urban settings.

Despite the lifesaving potential of HIV pre-exposure prophylaxis (PrEP), only 1-2% of people who inject drugs (PWID) use it.

The intensely negative stigma surrounding both HIV and injection drug use may be preventing people at high risk for HIV from using PrEP. However, this becomes even more disparate in rural areas, where PWID have little to no knowledge of PrEP and PrEP prescribers are significantly more biased against PWID.

Suzan Walters, PhD, Research Assistant Professor in the NYU School of Global Public Health, affiliated investigator at the Center for Drug Use and HIV/HCV Research, and faculty affiliate at the Center for Opioid Epidemiology and Policy, sat down with Contagion to discuss her recently-published paper, “PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure.”

Walters breaks down the PrEP care continuum, with stages ranging from PrEP awareness, to knowledge, to willingness, to uptake. By examining the PrEP care continuum involvement by rural versus urban setting, Walters identifies disproportionately low PrEP usage and high stigma in rural southern Illinois.

Walters says, “For me, PrEP is just another example of inequity in society.” She was originally motivated to pursue this study topic after the Scott County, Indiana HIV outbreak in 2015, an outbreak attributed to injection drug use that occurred while Walters was working with individuals in syringe service programs.

Walters’s work broadly centers around people who inject drugs and societal inequities in biomedical intervention.

In this first segment of a 2-part interview, Walters introduces her research, the impetus behind the topic, and presents the findings.

You can read Contagion’s original coverage of the study here.

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