Left to right: Kerry Miley, Erin McDowell, and Tamica Matos of the TIARAS program.
In honor of National Women and Girls HIV/AIDS Awareness Day, we are featuring Drexel University’s TIARAS program — Trauma Intervention to Optimize PrEP Among Women Who Inject Drugs. We spoke with Kerry Miley, who coordinates TIARAS on site at Prevention Point Philadelphia and collaborates regularly with our HIV testing and prevention teams.
What is TIARAS and the significance of the research?
The TIARAS study engages women who inject drugs in PrEP care as a way to prevent HIV. The reason our study focuses on women in particular is that women have historically been left out of the research and conversations around PrEP. A lot of the marketing around PrEP tends to focus heavily on men who have sex with men, to the point that a lot of the public doesn’t realize that women can take PrEP!
The study is still really new but we’re getting heartening findings just from what participants are telling us. One is that the TIARAS program is the first time many participants have heard about PrEP. They get so inspired by it that they feel empowered to tell other women in their lives about PrEP through the close-knit networks here in Kensington. That’s been really exciting to see unfold.
What is the TIARAS team like?
Our team is a fascinating and brilliant group of women who have a diversity of experience that makes them excellent for doing this type of research, from personal life experience in Kensington to different areas of study like counseling, human services and public health. They are very passionate about this work and excellent at engaging participants.
What are some of the research methods TIARAS utilizes?
Our team started volunteering regularly with the Womxn’s Night program at PPP a full year before we started recruiting participants. We wanted to build rapport among women that are served by PPP. It can take a long time to build trust in this community – understandably. A lot of our participants have been wounded by medical systems in the past.
Participants absolutely adore the staff at Prevention Point and everyone who has helped them get to the point of meeting with a doctor.
When it comes to recruitment and engagement, in an ideal scenario we’re able to be recognized by people out in the community and have already built that friendship and trust. Then it becomes very natural to let them know that we’re recruiting for a study to help prevent HIV. From there we’re able to link people to other services at PPP, mainly the PrEP and testing teams who help navigate women the clinic.
When we see our participants, we get so many cool shout-outs about the testing and PrEP teams as well as the medical reception staff. Participants absolutely adore the staff at Prevention Point and everyone who has helped them get to the point of meeting with a doctor. They love their providers as well.
A lot of women share negative experiences with getting linked to medication at other places and say it’s so different here—that staff are supportive, non-judgmental, and so understanding. That’s been really exciting to hear and it’s definitely something that has helped women stay engaged in PrEP.
What are some of the barriers that women encounter to getting on PrEP?
I definitely think there are stigmas around PrEP that can be a barrier, namely that some people associate PrEP with HIV treatment and think that being seen with PrEP might make others think that they have HIV rather than that they are trying to prevent HIV. Linking people with Leo and Hallima of the PrEP Clinic at PPP has helped mitigate some of that misinformation.
Having long-acting injectable PrEP available to women here at PPP has been a game-changer!
Some of the biggest barriers for a lot of the women in this study come down to adherence. TIARAS is actually building on top of research that my team and Dr. Alexis Roth conducted in 2018-19 back when PrEP was only available in pill form. That study found that women were really interested in starting PrEP if they could get it at their syringe service program. However, they had all sorts of problems when it came to adhering to the medication. Because it was a daily oral pill, it was very difficult for women to take it regularly enough for it to actually protect them against HIV.
When it comes to the PrEP pill, we know you need to take it at least six days out of the week in order for it to work. In our population, very few people were able to get to that six days a week due to competing priorities, homelessness, and forgetfulness. It's hard to remember to take a medication every single day, especially if you’re living on the street. Women in that study were also getting their possessions stolen regularly, losing their medications... Some of the women got incarcerated and were kept from taking their PrEP medications while they were imprisoned.
Now, having long-acting injectable PrEP available to women here at PPP has been a game-changer!
Do you have anything else to add about TIARAS or working on site at PPP?
I just can’t stress enough the positive things we hear from participants. Even on bad days they have so much appreciation for the people here at PPP and that is something I try and share with the staff. That’s been one of the more heartening things about working here — seeing all the love between staff and participants.