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Ribas Rietti Souto A, Aikhuele E, Esposito M, Rainer C, Budhwani H, Hightow-Weidman L, Tolley B, Maragh-Bass A. Patient and Provider Perceptions of Barriers and Facilitators to Pre-exposure Prophylaxis Access and Adherence in Black and Latinx Young Men Who Have Sex with Men. AIDS Patient Care STDS 2024; 38:315-323. [PMID: 38916119 DOI: 10.1089/apc.2024.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
In the United States, the use of pre-exposure prophylaxis (PrEP) has led to a substantial decrease in HIV prevalence and incidence. However, some populations, including young men who have sex with men (YMSM) of color, continue to be disproportionately impacted, highlighting the need for tailored interventions addressing barriers to adequate PrEP access. In collaboration with partner clinics, we recruited 19 PrEP clients and 19 PrEP providers (n = 35) to participate in hour-long in-depth interviews. Although client interviews explored personal experiences with stigma, barriers, and motivators to PrEP and information preferences, provider interviews explored providers' perceived stigma in their clinic, perceived barriers and motivators to meeting clients' PrEP needs, and rapport building with clients. Most participants were affiliated with one of the southern partner clinics. Clients and providers noted similar determinants to PrEP access, uptake, and adherence. Both recognized the impact of personal barriers such as routine adjustments and perception of need, as well as institutional barriers such as transportation and financial difficulties. Clients emphasized the role of the client-provider relationship as part of contributing to willingness to disclose information such as HIV status and sexual practices. Providers noted the importance of sexual health and LGBTQ+ topics in their training. Despite limited geographical scope and the sensitive nature of HIV-related topics, this study has several implications. PrEP clinics may benefit from hiring providers who share identities and experiences with YMSM clients of color and operating with a flexible schedule. Medical provider training should include comprehensive sexual health and LGBTQ+ competencies to reduce bias in care.
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Affiliation(s)
- Amanda Ribas Rietti Souto
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences (BECS) Division, Durham, North Carolina, USA
| | - Ese Aikhuele
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences (BECS) Division, Durham, North Carolina, USA
| | - Maria Esposito
- The University of North Carolina at Chapel Hill (NC), Center for Health Equity Research, Chapel Hill, North Carolina, USA
| | - Crissi Rainer
- Florida State University College of Nursing, Tallahassee, Florida, USA
| | - Henna Budhwani
- Florida State University College of Nursing, Tallahassee, Florida, USA
| | | | - Betsy Tolley
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences (BECS) Division, Durham, North Carolina, USA
| | - Allysha Maragh-Bass
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences (BECS) Division, Durham, North Carolina, USA
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Kota KK, Gelaude D, Carnes N, Schoua-Glusberg A, Frew PM, Randall L, Gale B, Betley V, Mansergh G. Low Self-Perceived Need for PrEP and Behavioral Indications of MSM Who Recently Refused Daily PrEP: A Mixed Methods Study in Three U.S. Cities. AIDS Behav 2024; 28:1845-1857. [PMID: 38457051 PMCID: PMC11216258 DOI: 10.1007/s10461-024-04276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/09/2024]
Abstract
Pre-exposure prophylaxis (PrEP) reduces sexual risk for HIV transmission by 99% when used appropriately, but remains underutilized among gay, bisexual, and other men who have sex with men (MSM). In this mixed-method study, we describe reasons for PrEP refusal associated with low self-perceived need for PrEP among MSM who recently declined daily oral PrEP when offered by a provider. Data are from a quantitative behavioral survey of MSM (N = 93) living in Atlanta, Chicago, and Raleigh-Durham, who also either responded to an in-depth interview (n = 51) or participated in one of 12 focus groups (n = 42). Themes of low self-perceived need for PrEP were: low self-perceived risk for HIV acquisition (33% of respondents); confidence in remaining HIV-negative (35%); using condoms (81%); limiting number of partners and choosing partners carefully (48%); asking partners about their HIV status before having sex (45%); engaging in safer sexual positions or oral sex (28%); being in a monogamous relationship or exclusivity with one partner (26%); and regular HIV testing (18%). Low self-perceived risk for HIV acquisition and high confidence in other prevention strategies were important factors related to low self-perceived need in MSM refusing daily oral PrEP when offered. Providers should continue to discuss the benefits of PrEP as a safe and highly effective option for HIV prevention.
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Affiliation(s)
- Krishna Kiran Kota
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS H18-3, Atlanta, GA, USA.
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
| | - Deborah Gelaude
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS H18-3, Atlanta, GA, USA
| | - Neal Carnes
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS H18-3, Atlanta, GA, USA
| | | | - Paula M Frew
- Emory University School of Medicine, Atlanta, GA, USA
- Emory University Rollins School of Public Health, Atlanta, GA, USA
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - Laura Randall
- Emory University School of Medicine, Atlanta, GA, USA
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Bryan Gale
- American Institutes for Research, Arlington, VA, USA
| | | | - Gordon Mansergh
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS H18-3, Atlanta, GA, USA
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Mansergh G, Sullivan PS, Kota KK, Daskalakis D. Pre-exposure prophylaxis in the era of emerging methods for men who have sex with men in the USA: the HIV Prevention Cycle of Care model. Lancet HIV 2023; 10:e134-e142. [PMID: 36525980 PMCID: PMC11283766 DOI: 10.1016/s2352-3018(22)00309-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/22/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022]
Abstract
Expanding on previous work, we present an HIV Prevention Cycle of Care model to facilitate understanding of the complexity of issues involved in pre-exposure prophylaxis implementation for gay, bisexual, and other men who have sex with men (MSM) in the USA, including individual, client-provider, and overarching issues such as health equity, stigma, and prevention nomenclature. The HIV prevention cycle of care applies to MSM who test negative for HIV. The Prevention Cycle of Care model includes seven steps: prevention knowledge, prevention self-awareness and preferences, prevention motivation, health-care access and cost, provider issues, adherence and persistence, and periodic reassessment and adjustment. HIV prevention is complex in an era of emerging multiple modalities, and more research is needed to successfully implement pre-exposure prophylaxis options over time and across diverse communities of MSM who are sexually active.
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Affiliation(s)
- Gordon Mansergh
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Patrick S Sullivan
- Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Krishna Kiran Kota
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Demetre Daskalakis
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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