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Hill MJ, Sapp S, McCants S, Campbell J, Taylor A, Stockman JK, Santa Maria D. An Examination of Perceptions among Black Women on Their Awareness of and Access to Pre-Exposure Prophylaxis (PrEP). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1084. [PMID: 39200693 PMCID: PMC11354061 DOI: 10.3390/ijerph21081084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/09/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024]
Abstract
Cisgender Black women (CBW) experience 67% of new HIV diagnoses among women in the South. Progress toward ending the HIV epidemic requires researchers to explore perceptions of factors related to the decision to initiate pre-exposure prophylaxis (PrEP) among CBW. Qualitative methods were used to explore how social and structural constructs influence individual decisions to use PrEP among 20 CBW through focus groups. The thematic data analysis identified how facilitators and barriers to PrEP uptake aligned with an external locus of control (LOC) [e.g., media influences on understanding of PrEP] or an internal LOC (e.g., awareness of personal vulnerability to HIV). Several participants highlighted that their PrEP knowledge was rooted in an external LOC, such as media campaigns. A participant stated, 'But even with the commercial, it wasn't representation for me.' Another participant described her personal HIV vulnerability in her sexual relationship as an internal LOC, stating, 'Not ignorance, it's maybe just not accepting the true reality of this can be contracted even from someone that you believe that you trust.' Due to gaps in media marketing, healthcare providers should be aware that some female patients may perceive that PrEP is not for them. Provider-led sexual health discussions are urgently needed to bridge the gap between PrEP eligibility and initiation.
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Affiliation(s)
- Mandy J. Hill
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA; (S.S.); (A.T.)
| | - Sarah Sapp
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA; (S.S.); (A.T.)
| | - Shadawn McCants
- Allies in Hope Houston, Houston, TX 77030, USA; (S.M.); (J.C.)
| | | | - Akeria Taylor
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA; (S.S.); (A.T.)
| | - Jamila K. Stockman
- Department of Medicine, University of California, La Jolla, San Diego, CA 92093, USA;
| | - Diane Santa Maria
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX 77030, USA;
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Goddard-Eckrich D, McCrimmon T, Bond K, Chang M, Hunt T, Hall J, Russo M, Ramesh V, Johnson KA, Downey DL, Wu E, El-Bassel N, Gilbert L. Effectiveness of a culturally tailored HIV intervention in promoting PrEP among black women who use drugs in community supervision programs in New York City: a randomized clinical trial. Addict Sci Clin Pract 2024; 19:55. [PMID: 39039560 PMCID: PMC11264441 DOI: 10.1186/s13722-024-00488-0] [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] [Received: 09/12/2023] [Accepted: 07/12/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND In the U.S. there are significant racial and gender disparities in the uptake of pre-exposure prophylaxis (PrEP). Black Americans represented 14% of PrEP users in 2022, but accounted for 42% of new HIV diagnoses in 2021 and in the South, Black people represented 48% of new HIV diagnoses in 2021 but only 21% of PrEP users in 2022. Women who use drugs may be even less likely than women who do not use drugs have initiated PrEP. Moreover, women involved in community supervision programs (CSP) are less likely to initiate or use PrEP, More PrEP interventions that focus on Black women with recent history of drug use in CSPs are needed to reduce inequities in PrEP uptake. METHODS We conducted a secondary analysis from a randomized clinical trial with a sub-sample (n = 336) of the total (N = 352) participants from the parent study (E-WORTH), who tested HIV negative at baseline were considered PrEP-eligible. Black women were recruited from CSPs in New York City (NYC), with recent substance use. Participants were randomized to either E-WORTH (n = 172) an HIV testing plus, receive a 5-session, culturally-tailored, group-based HIV prevention intervention, versus an HIV testing control group (n = 180). The 5 sessions included an introduction to PrEP and access. This paper reports outcomes on improved awareness of PrEP, willingness to use PrEP, and PrEP uptake over the 12-month follow-up period. HIV outcomes are reported in a previous paper. RESULTS Compared to control participants, participants in this study assigned to E-WORTH had significantly greater odds of being aware of PrEP as a biomedical HIV prevention strategy (OR = 3.25, 95% CI = 1.64-6.46, p = 0.001), and indicated a greater willingness to use PrEP as an HIV prevention method (b = 0.19, 95% CI = 0.06-0.32, p = 0.004) over the entire 12-month follow-up period. CONCLUSIONS These findings underscore the effectiveness of a culturally-tailored intervention for Black women in CSP settings in increasing awareness, and intention to initiate PrEP. Low uptake of PrEP in both arms highlight the need for providing more robust PrEP-on-demand strategies that are integrated into other services such as substance abuse treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02391233 .
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Affiliation(s)
- Dawn Goddard-Eckrich
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA.
| | - Tara McCrimmon
- Sociomedical Sciences Department at the Mailman School of Public Health, 722 W. 168th Street, 16th floor, New York, NY, 10032, USA
| | - Keosha Bond
- School of Medicine, Community Health & Social Medicine, City University of New York, Harris Hall, H-313I, New York, NY, 10031, USA
| | - Mingway Chang
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
| | - Timothy Hunt
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
| | - Jennifer Hall
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
| | - Mary Russo
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
| | - Vineha Ramesh
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
| | - Karen A Johnson
- University of Alabama School of Social Work, Box 870314, Tuscaloosa, AL, 35487-0314, USA
| | - Dget L Downey
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Elwin Wu
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
| | - Nabila El-Bassel
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
| | - Louisa Gilbert
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
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Thorpe S, Orphé P, Pitcher G, McCleod K, Malone N, Stevens-Watkins D. Correlates of Transactional Sex Among Black Men and Women Who Misuse Opioids. HEALTH EDUCATION & BEHAVIOR 2024; 51:416-424. [PMID: 38281101 PMCID: PMC11200108 DOI: 10.1177/10901981231225440] [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: 01/29/2024]
Abstract
The rise in opioid misuse coincides with increased sexually transmitted infection (STI) and HIV incidence. Transactional sex is an under-researched phenomenon among Black Americans who misuse opioids, and may increase their risk of STI or HIV transmission. Given the disproportionate impact of the opioid epidemic on Black Americans and the risks associated with opioid misuse, the current study aims to investigate sociostructural factors, history of violence, and sexual risk factors associated with transactional sex among Black men and women. A sample of n = 375 Black adult Kentuckians reporting opioid misuse completed a survey including transactional sex, sociostructural, violence history, and sexual risk measures. Results of chi-squares and independent samples t-tests revealed that compared to men who did not report engaging in transactional sex, men who engaged in transactional sex were less educated, reported being sexually assaulted or having an unwanted sexual experience in their lifetime, and were more likely to use opioids or cocaine before or during sex in the last year. Women who engaged in transactional sex had a history of violence, more structural barriers, higher psychological distress, and engaged in more sexual risk behaviors compared to women who did not engage in transactional sex. Implications for future research and interventions with this population are discussed.
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Pitchford K, Shangani S, Dawson C, Masa R, Heron K. Community Health Care Providers' Perspectives on Human Immunodeficiency Virus Pre-Exposure Prophylaxis Use Among Black Women in Eastern Virginia. AIDS Patient Care STDS 2024; 38:123-133. [PMID: 38471092 DOI: 10.1089/apc.2023.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
The most at-risk population among women for human immunodeficiency virus (HIV) diagnosis in the United States are Black women, accounting for 61% of all new HIV cases. Pre-exposure prophylaxis (PrEP) is a safe and effective HIV prevention method for people at risk of HIV acquisition. Although disproportionately affected by HIV, Black women's knowledge, perceived benefits, and uptake of PrEP remain low. The socioecological model (SEM) may be useful for understanding why there is a low uptake of PrEP among Black women. The current study used the SEM to explore provider perspectives on the barriers and facilitators of PrEP uptake among Black women in Eastern Virginia. Semistructured interviews were conducted with a total sample of 15 community health care providers. Barriers of PrEP uptake at the societal (e.g., PrEP advertisements focus on gay men), community/organizational (e.g., time constraints in the workplace), interpersonal (e.g., perceived monogamy), and individual (e.g., unmet basic needs) levels were identified. Providers also identified facilitators of PrEP uptake at the societal (e.g., PrEP advertisements that target women), community/organizational (e.g., PrEP education), interpersonal (e.g., HIV-positive partner), and individual (e.g., PrEP awareness and perceived susceptibility to HIV) levels. These findings highlight unique barriers to accessing and taking PrEP for Black women in the United States, and potential factors that could facilitate PrEP use. Both barriers and facilitators may be important targets for interventions to improve PrEP uptake. Future research focused on improving PrEP uptake among Black women in the United States should consider multi-level interventions that target barriers and facilitators to reduce rates of HIV infections.
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Affiliation(s)
- Kayla Pitchford
- The Virginia Consortium Program in Clinical Psychology, Old Dominion University, Norfolk, Virginia, USA
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Sylvia Shangani
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts, USA
- Social and Behavioral Sciences Department, Yale School of Public Health, New Haven, Connecticut, USA
| | - Charlotte Dawson
- The Virginia Consortium Program in Clinical Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Rainier Masa
- School of Social Work, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kristin Heron
- The Virginia Consortium Program in Clinical Psychology, Old Dominion University, Norfolk, Virginia, USA
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
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Nydegger LA, Kidane H, Benitez S, Yuan M, Claborn KR. A Qualitative Exploration of PrEP Interests, Barriers, and Interventions Among Black and Latina Cisgender Women in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:771-783. [PMID: 37796358 PMCID: PMC10844362 DOI: 10.1007/s10508-023-02712-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 08/28/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
Black and Latina cisgender women (BLCW) are disproportionally affected by HIV, particularly in the southern U.S. In Austin, Texas, Black women contract HIV 18.4 times more and Latinas 2.6 times more compared to White women. Pre-exposure prophylaxis (PrEP) is a medication that prevents contracting HIV; however, PrEP adoption among women is low. The current qualitative study aimed to explore PrEP awareness, interest, preferred PrEP administration methods, barriers to PrEP adoption, and future programs to increase PrEP adoption and adherence among BLCW. A total of 18 BLCW at high risk for HIV were enrolled. Participants completed 3 semi-structured interviews across 3 months. Interviews were transcribed verbatim, coded, and analyzed using thematic content analysis. Results demonstrated that BLCW had low PrEP awareness, high initial PrEP interest, and were interested in a long-acting injectable form of PrEP. Barriers to PrEP adoption included concerns regarding side effects, concerns about adherence to the currently available daily pill, and difficulty with insurance. Participants proposed different ideas for interventions, including support groups, education, community-level programs, and structural interventions. Future studies should focus on increasing PrEP awareness and HIV risk, consider alternative forms of PrEP, educate providers and medical staff on PrEP, and consider tailored interventions to reduce HIV risk among BLCW.
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Affiliation(s)
- Liesl A Nydegger
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Hampton House, 624 N. Broadway Street, Baltimore, MD, 21205, USA.
| | - Heran Kidane
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA
| | - Sabrina Benitez
- Department of Molecular Biosciences, University of Texas at Austin, Austin, TX, USA
| | - Mandy Yuan
- School of Human Ecology, University of Texas at Austin, Austin, TX, USA
| | - Kasey R Claborn
- School of Social Work, University of Texas at Austin, Austin, USA
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Sophus AI, Mitchell JW, Barroso J, Sales JM. Factors Associated with Planned Future Use of PrEP in the Next 3 Months and Likelihood to Use PrEP Among Black Cisgender HIV-negative Women in Texas. AIDS Behav 2024; 28:72-92. [PMID: 37768428 DOI: 10.1007/s10461-023-04188-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
Identifying and then addressing barriers and leveraging facilitators is important to help increase pre-exposure prophylaxis (PrEP) use among Black women vulnerable to HIV acquisition. The present cross-sectional study examined what factors were associated with future plans to use PrEP, and general likelihood to use it among a convenience sample of 152 adult, Black cisgender women from three metropolitan areas in Texas. The final multivariable logistic regression model revealed that relationship status (aOR = 0.20, 95% CI: 0.05-0.73, p < 0.05), PrEP anticipated stigma (aOR = 0.29, 95% CI: 0.10-0.78, p < 0.05), perceived discrimination (aOR = 0.40, 95% CI: 0.21-0.78, p < 0.01) and interest in learning more about PrEP (aOR = 5.32, 95% CI: 2.60-10.9, p < 0.001) were associated with future plans to use PrEP. The final multivariable linear regression model with maximum likelihood estimation identified that perceived discrimination (β=-0.24, SE: -0.38 - -0.10, p < 0.01), perceived HIV risk (β = 0.33, SE: 0.18-0.49, p < 0.001), willingness to use PrEP with condoms (β = 1.26, SE: 0.94-1.60, p < 0.001), and comfort communicating about PrEP with a provider (β = 0.23, SE: 0.06-0.41, p < 0.01) were associated with general likelihood to use PrEP. Findings reveal key factors that warrant further attention and examination toward improving PrEP use within this population.
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Affiliation(s)
- Amber I Sophus
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA.
| | - Jason W Mitchell
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
| | - Julie Barroso
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Jessica McDermott Sales
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Ichite A, Jean-Gilles M, Rosenberg R, Abbamonte J, Dévieux JG. Assessing the Preliminary Efficacy of a Nonrandomized, Clinic-Based HIV Risk Reduction Pilot Intervention for PrEP-Initiated, Alcohol- and Other Drug-Using Women of Color in Miami, FL. J Racial Ethn Health Disparities 2023; 10:3077-3094. [PMID: 36648620 PMCID: PMC10645637 DOI: 10.1007/s40615-022-01482-5] [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] [Received: 10/04/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 01/18/2023]
Abstract
In this paper, we assessed the preliminary efficacy and acceptability of a quasi-experimental, clinic-based sexual risk reduction pilot intervention for pre-exposure prophylaxis (PrEP)-initiated, alcohol- and other drug-using women of color and explored their self-reported barriers to, and facilitators of, PrEP use. Using a mixed methods design, analyses incorporated pre- and post-intervention study assessment data from 38 women and semi-structured process evaluations using a subsample of 25. The intervention administered over an 8-week period consisted of 4 one-on-one in person educational sessions, a process evaluation, and study assessments conducted at baseline and 3 and 6 months. Post intervention, statistically significant changes in sexual risk scores were not observed; however, we found significant decreases in alcohol use (Z = - 3.02, p = .003, η2 = .41). Process evaluation data revealed interpersonal relationships as a key motivator for PrEP initiation as well as a prominent barrier to PrEP use; these relationships rarely facilitated adherence. Overall, women found the intervention to be acceptable and reported a wide range of benefits of participation-most notably its therapeutic benefits. Findings from this study provide preliminary evidence of the potential for the Talking PrEP with Women of Color intervention to improve risky behaviors, knowledge, and attitudes related to sexual risk taking. Furthermore, findings suggest that interventions to increase PrEP uptake and adherence in at-risk women may benefit from supporting them in accurately estimating their risk for HIV and increasing their sense of social support.
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Affiliation(s)
- Amanda Ichite
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA.
| | - Michèle Jean-Gilles
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA
| | - Rhonda Rosenberg
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA
| | - John Abbamonte
- Department of Educational and Psychological Studies, Counseling Psychology Area, University of Miami, Coral Gables, FL, 33146, USA
| | - Jessy G Dévieux
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA
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Irie W, Mahone A, Nakka R, Ghebremichael M. Confidence in Ability to Communicate With Sexual Partners About PrEP Among Black Cisgender Women. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:333-346. [PMID: 37843905 DOI: 10.1521/aeap.2023.35.5.333] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
This study explored the factors associated with Black women's confidence in their ability to engage male sexual partners in discussions about PrEP. Communication about PrEP with male partners is an important, yet minimally explored, outcome in PrEP research among Black women in heterosexual partnerships. Among 315 respondents, results show significant differences in anticipated stigma and interest in PrEP between a binary outcome variable being confident and not-confident discussing PrEP with sexual partners. Further, factors such as employment, worrying about HIV infection, interest in taking oral PrEP, subjective norms, injunctive norms, and descriptive norms were associated with Black women's higher odds of confidence in their ability to engage sexual partners about PrEP. Conversely, PrEP disapproval and stigma resulted in lower odds of Black women's confidence in their ability to engage sexual partners about PrEP. Results indicate the need for continued investigation of confidence and, relatedly, communication about PrEP among heterosexual couples and communitylevel interventions normalizing PrEP discussions and uptake.
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Affiliation(s)
- Whitney Irie
- Boston College School of Social Work, Chestnut Hill, Massachusetts, and The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Anais Mahone
- School of Social Work, Rutgers University, New Brunswick, New Jersey
| | - Raja Nakka
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts
| | - Musie Ghebremichael
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School, Cambridge, Massachusetts
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Troutman J, Robillard A, Ingram LA, Qiao S, Gaddist B, Segosebe K. Individual, Social, and Structural Vulnerability for Black Women in the South: Implications for PrEP. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:290-308. [PMID: 37535327 DOI: 10.1521/aeap.2023.35.4.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, yet adoption among Black women, who are disproportionately impacted by HIV, is low. A nuanced understanding of the multi-level factors that contribute to elevated risk is necessary to better contextualize PrEP uptake. Qualitative data from Black women residing in the Southern U.S. who self-screened as HIV-negative, were collected via four focus groups (N = 27) to understand influences on HIV vulnerability and the potential role of PrEP in mitigating risk. Content analysis of transcribed data yielded multiple themes addressing: the pervasiveness of sexual partner sharing; lack of transparency regarding HIV status, disclosure, and testing; and social/cultural influences on HIV risk. Experiences with the health care system and providers were of particular concern. Findings demonstrate support for PrEP in this population and contribute to our understanding of individual, social, and structural factors to better inform PrEP promotion.
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Affiliation(s)
- Jamie Troutman
- Quality Comprehensive Health Center, Charlotte, North Carolina
| | - Alyssa Robillard
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Lucy Annang Ingram
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Shan Qiao
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Kebafe Segosebe
- Edson College of Nursing and Health Innovation, Arizona State University
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McMahon JM, Simmons J, Braksmajer A, LeBlanc N. HIV-serodifferent couples' perspectives and practices regarding HIV prevention strategies: A mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000620. [PMID: 36962775 PMCID: PMC10022221 DOI: 10.1371/journal.pgph.0000620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022]
Abstract
A substantial proportion of heterosexually acquired HIV infections in the U.S. occur between partners in primary relationships characterized by mixed HIV status. The U.S. Centers for Disease Control and Prevention have issued guidelines prioritizing HIV-serodifferent couples for primary HIV prevention, including treatment-as-prevention and pre-exposure prophylaxis (PrEP). Yet, very little research has been conducted to understand the perspectives and practices of HIV-serodifferent couples regarding HIV prevention strategies in the U.S. To help fill this gap, we conducted a mixed methods study with 27 mostly Black/African American and Latinx HIV-serodifferent heterosexual couples residing in New York City to explore their knowledge, attitudes, practices, and perspectives regarding combination HIV prevention, including condoms, PrEP and viral control. All couples expressed the desire to maintain viral suppression in the HIV-positive partner, which was not always achieved. There was considerable heterogeneity in the use of HIV prevention methods by couples; and several patterns emerged that were largely driven by gender and relationship dynamics. Female partners, in particular, expressed high levels of anxiety around transmission of HIV and thus desired multiple methods of protection. Healthcare providers should consider couples' psychosocial well-being, relationship quality, and other motivational factors when helping to tailor HIV preventative care for mixed-status couples.
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Affiliation(s)
- James M. McMahon
- School of Nursing, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Janie Simmons
- School of Global Public Health, New York University, New York, New York, United States of America
| | - Amy Braksmajer
- Department of Sociology, State University of New York at Geneseo, Geneseo, New York, United States of America
| | - Natalie LeBlanc
- School of Nursing, University of Rochester Medical Center, Rochester, New York, United States of America
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Villalba K, Jean-Gilles M, Rosenberg R, Cook RL, Ichite A, Martin P, Dévieux JG. Understanding the Impact of Intimate Partner Violence Type and Timing on Pre-exposure Prophylaxis Knowledge, Acceptability, Sexual Behavior, and Gender Roles Among Women of Color. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP12998-NP13017. [PMID: 33752483 DOI: 10.1177/08862605211001468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Knowledge and acceptability are key factors for pre-exposure prophylaxis (PrEP) use among women with a history of intimate partner violence (IPV) and research suggests that different types of IPV affect PrEP uptake differently. Few studies have examined whether the type (i.e., physical, sexual, and psychological) and timing (i.e., lifetime, past year) of IPV experiences are related to PrEP knowledge and acceptability, or whether gender roles and sexual risk behaviors affect PrEP use. We aimed to examine the associations between lifetime and past-year physical, sexual, and psychological IPV experiences on PrEP-related outcomes (i.e., knowledge, acceptability, sexual behavior if on PrEP) and the association between gender roles and PrEP-related outcomes. A total of 186 women of color at risk for HIV participated in this study, of whom 54% had ever experienced partner violence. Results showed that lifetime psychological (OR 3.0, 95% CI 1.1-9.4) and lifetime physical IPV (OR 5.5, 95% CI 1.2-18.9) were significantly associated with increased PrEP knowledge. lifetime psychological (OR 6.3, 95% CI 1.0-13.6) and lifetime physical IPV (OR 4.3, 95% CI 4.3-11.5) were significantly associated with increased sexual behavior if on PrEP. Past year physical IPV was significantly associated with interest in using PrEP (OR 1.9, 95% CI 1.7-4.3) and with sexual behavior if on PrEP (OR 4.0, 95% CI 1.1-13.1). Being subordinate to others was also significantly associated with interest in using PrEP (OR 1.5, 95% CI 1.2-2.4) Self-silencing was significantly associated with increased sexual behavior if on PrEP (OR 1.2, 95% CI 1.0-1.5). Gender norms and IPV type and timing can influence whether a person is interested in PrEP use. Both lifetime and past-year IPV experiences need to be examined in the context of gender norms when prescribing PrEP to encourage uptake and continuation among vulnerable women at risk for HIV.
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Irie WC, Calabrese SK, Patel RR, Mayer KH, Geng EH, Marcus JL. Preferences for HIV Preexposure Prophylaxis Products Among Black Women in the U.S. AIDS Behav 2022; 26:2212-2223. [PMID: 34985607 PMCID: PMC9167149 DOI: 10.1007/s10461-021-03571-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 01/27/2023]
Abstract
In a nationwide sample of Black women in the U.S., we assessed preferences for HIV preexposure prophylaxis (PrEP) products, including long-acting injectable (LAI) PrEP and once-daily oral PrEP. Among 315 respondents, 32.1% were aware of PrEP and 40.6% were interested in using it; interest increased to 62.2% if PrEP were provided for free. Oral PrEP was the preferred option (51.1%), followed by LAI PrEP (25.7%), vaginal gel (16.5%), and vaginal ring (6.7%). When examining oral and LAI PrEP alone, most (62.7%) preferred oral PrEP. LAI PrEP was more likely to be preferred among respondents with concerns about healthcare costs or PrEP-related stigma, and among those who reported inconsistent condom use and multiple sexual partners. Although most Black women preferred oral PrEP, LAI PrEP may be appealing to a subset with social and structural barriers to PrEP use, such as cost and stigma, and those at increased risk of HIV infection.
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Affiliation(s)
- Whitney C Irie
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Dr, Ste 401, Boston, MA, 02215, USA.
| | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Rupa R Patel
- Division of Infectious Diseases, Washington University in St Louis, St. Louis, MO, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Elvin H Geng
- Division of Infectious Diseases, Washington University in St Louis, St. Louis, MO, USA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
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13
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Pyra M, Johnson AK, Devlin S, Uvin AZ, Irby S, Stewart E, Blum C, Green M, Haider S, Hirschhorn LR, Ridgway JP. HIV Pre-exposure Prophylaxis Use and Persistence among Black Ciswomen: "Women Need to Protect Themselves, Period". J Racial Ethn Health Disparities 2022; 9:820-829. [PMID: 33733424 PMCID: PMC7968858 DOI: 10.1007/s40615-021-01020-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/01/2021] [Accepted: 03/07/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Disparities in HIV incidence and PrEP use among Black ciswomen remain. We examine factors associated with PrEP persistence using mixed methods. SETTING Black ciswomen in Chicago, IL, prescribed PrEP at a federally qualified health center (FQHC). METHODS We used electronic health data to determine PrEP persistence (Proportion of Days Covered ≥86% at 6 months) and tested demographic and clinical factors in logistic regressions. We interviewed eight Black ciswomen, purposefully selected by PrEP persistence. RESULTS Among 112 Black ciswomen, 18% were persistent. In adjusted models, neighborhood, visit reason (at initiation), and initiation year were significantly associated with persistence. Qualitatively, we found little evidence of cost or adherence as barriers; participants reported low community awareness, importance of providers, and concerns around stigma, side effects, and pregnancy while using PrEP. CONCLUSION While persistence among Black ciswomen was low, patients were often making decisions based on perceived HIV risk. We identified real-world barriers to address in future interventions.
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Affiliation(s)
- Maria Pyra
- Howard Brown Health, Chicago, IL, USA.
- Department of Medicine, University of Chicago, Chicago, IL, USA.
| | - Amy K Johnson
- Ann & Robert H. Luries Children's Hospital of Chicago, Chicago, IL, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Samantha Devlin
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - A Ziggy Uvin
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | | | - Cori Blum
- Howard Brown Health, Chicago, IL, USA
| | | | - Sadia Haider
- Department of Obstetrics-Gynecology, University of Chicago, Chicago, IL, USA
| | - Lisa R Hirschhorn
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jessica P Ridgway
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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14
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Evans KN, Hassan R, Townes A, Buchacz K, Smith DK. The Potential of Telecommunication Technology to Address Racial/Ethnic Disparities in HIV PrEP Awareness, Uptake, Adherence, and Persistence in Care: A Review. AIDS Behav 2022; 26:3878-3888. [PMID: 35614366 PMCID: PMC9131988 DOI: 10.1007/s10461-022-03715-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is highly effective in preventing new HIV infection, but uptake remains challenging among Black and Hispanic/Latino persons. The purpose of this review was to understand how studies have used electronic telecommunication technology to increase awareness, uptake, adherence, and persistence in PrEP care among Black and Hispanic/Latino persons and how it can reduce social and structural barriers that contribute to disparities in HIV infection. Of the 1114 articles identified, 10 studies were eligible. Forty percent (40%) of studies focused on Black or Hispanic/Latino persons and 80% addressed social and structural barriers related to PrEP use such as navigation or access to PrEP. Mobile health designs were more commonly used (50%) compared to telehealth (30%) and e-health (20%) designs. There is a need to increase the development of telecommunications interventions that address the needs of Black and Hispanic/Latino persons often challenged with uptake and adherent use of PrEP.
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15
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Pre-exposure Prophylaxis (PrEP) Initiation Among Black and Latina Cisgender Women Receiving HIV Prevention Care Coordination Services in New York City. AIDS Behav 2022; 26:3174-3184. [PMID: 35362904 DOI: 10.1007/s10461-022-03661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/01/2022]
Abstract
Black and Latina cisgender women are disproportionately impacted by HIV in the US. Although PrEP is effective at preventing HIV infection, uptake in this population remains low. The aim of the study was to examine sociodemographic, behavioral, clinical, and psychosocial factors associated with PrEP initiation (defined as receiving a PrEP prescription) among 565 cisgender women enrolled in an HIV prevention services coordination program in NYC from January 2017 to December 2019 who met HIV risk criteria for PrEP. Of these, 26% initiated PrEP. Latina women were significantly more likely than white women to have initiated PrEP (Latina: 29.7%; Black: 26.1%; White: 16.3%; Other: 7.4%). PrEP initiation was significantly associated with PrEP awareness, an annual income < $20,000, being unstably housed, receiving benefits navigation services, and reporting non-injection drug use and/or a recent sexual relationship with an HIV-positive partner. The relatively low rate of PrEP initiation we observed suggests the need to increase PrEP access and uptake among women, particularly Black and Latina women who continue to be disproportionately at risk for HIV.
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16
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Mangum LC, Craddock JB, Whitfield DL. Associations in preventive sexual health service utilization and pre-exposure prophylaxis (PrEP) interest among young Black women in the United States, 2018. AIDS Care 2022; 34:324-330. [PMID: 33975482 PMCID: PMC8581060 DOI: 10.1080/09540121.2021.1925213] [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] [Received: 10/19/2020] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
Despite declines in HIV prevalence among all U.S. women, HIV remains a serious concern for Black women. PrEP is an effective biomedical intervention and has high acceptability among Black women. Therefore, offering PrEP, in addition to screening and testing for STI/HIV consistently, can reduce HIV risk among this population. We examine the associations of preventive sexual health service utilization (PSHSU) and PrEP interest among young Black women (YBW) (N = 209) in the United States in 2018. YBW, ages 18-25, completed a self-administered questionnaire, assessing sexual risk and prevention behaviors, HIV/STI testing, and PrEP interest. More than half of YBW were aware of PrEP and its benefits. YBW, who received an HIV test within the past three to six months, had higher odds of PrEP interest. The proportion of YBW who reported being interested in PrEP did not differ by PSHSU. Active contraceptive use was associated with PrEP interest. The results suggest YBW engage in preventive sexual health services, including HIV/STI testing, reproductive health, and sexual health behavioral counseling. Additional efforts should be made to normalize PrEP education for heterosexual, cisgender women at student health centers on college and university campuses, and other venues outside of traditional HIV/STI testing facilities.
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Affiliation(s)
- Laurenia C. Mangum
- School of Social Work, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jaih B. Craddock
- School of Social Work, University of Maryland, Baltimore, MD, USA
| | - Darren L. Whitfield
- Department of Psychiatry, School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
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17
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Bond KT, Gunn A, Williams P, Leonard NR. Using an Intersectional Framework to Understand the Challenges of Adopting Pre-exposure Prophylaxis (PrEP) Among Young Adult Black Women. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:180-193. [PMID: 35401855 PMCID: PMC8992539 DOI: 10.1007/s13178-021-00533-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 06/14/2023]
Abstract
Introduction There is limited functional knowledge and utilization of pre-exposure prophylaxis (PrEP) among young adult Black cisgender women (YBW). Methods We conducted four focus groups with YBW using an intersectional framework to explore multiple levels of factors that impede YBW awareness, interest, and utilization of PrEP in conjunction with their sexual and reproductive healthcare needs. Results Influences at the cultural-environmental level included a lack of information and resources to access to PrEP and medical mistrust in the healthcare system. At the social normative level, influences included attitudes towards the long-term effects on sexual and reproductive health and self-efficacy to follow the PrEP regimen. At the proximal intrapersonal level, influences included anticipated HIV stigma from family and peers along with the fear of rejection from their main partners. Conclusions Translation of these results indicated that interventions to increase PrEP utilization and adherence among YBW will require multi-level strategies to address barriers to integrating HIV prevention into sexual and reproductive healthcare.
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Affiliation(s)
- Keosha T. Bond
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, New York, United States
| | - Alana Gunn
- Department of Criminology, Law, and Justice, University of Illinois At Chicago, Chicago, Illinois, United States
| | - Porche Williams
- CUNY Lehman College, Bronx, New York, New York, United States
| | - Noelle R. Leonard
- Silver School of Social Work, New York University, New York, New York, United States
- Center for Drug Use and HIV Research, NYU School of Global Public Health, New York, New York, United States
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18
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Chandler R, Guillaume D, Wells J, Hernandez N. Let Me Prep You to PREP Me: Amplifying the Voices of Black Women and Their Providers to Consider PrEP as an HIV Prevention Option. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031414. [PMID: 35162438 PMCID: PMC8835000 DOI: 10.3390/ijerph19031414] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/08/2022] [Accepted: 01/23/2022] [Indexed: 02/04/2023]
Abstract
Despite the high efficacy of pre-exposure prophylaxis (PrEP) in preventing HIV acquisition, PrEP uptake among Black cisgender women remains low. Our qualitative study assessed Black cisgender women's perspectives, attitudes, and acceptability towards PrEP, in addition to exploring PrEP-related attitudes, facilitators, and barriers to PrEP access among health care staff. This study was conducted to ascertain data to inform the development of our HIV prevention app-Savvy HER-which is being designed for Black cisgender women. Our findings indicated that Black women had low levels of PrEP acceptability and high levels of misconceptions, inaccurate knowledge, and stigma towards PrEP. Health care providers in our sample confirmed barriers of stigma, misconceptions, and knowledge among their patients coupled with difficulty accessing PrEP due to structural barriers. Our study indicated that there is a critical need to heighten Black cisgender women's PrEP knowledge and HIV risk perception in order to increase PrEP acceptability and uptake.
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Affiliation(s)
- Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (R.C.); (J.W.)
| | - Dominique Guillaume
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (R.C.); (J.W.)
- School of Nursing, Johns Hopkins University, Baltimore, MD 21224, USA
- Correspondence:
| | - Jessica Wells
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (R.C.); (J.W.)
| | - Natalie Hernandez
- Community Health and Preventative Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA;
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19
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Grov C, Westmoreland DA, D’Angelo AB, Pantalone DW. How Has HIV Pre-Exposure Prophylaxis (PrEP) Changed Sex? A Review of Research in a New Era of Bio-behavioral HIV Prevention. JOURNAL OF SEX RESEARCH 2021; 58:891-913. [PMID: 34180743 PMCID: PMC9729849 DOI: 10.1080/00224499.2021.1936440] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
In 2012, the U.S. FDA approved the first drug for use as HIV Pre-Exposure Prophylaxis (PrEP), which is nearly 99% effective when taken as prescribed. Although the manifest function of PrEP is to prevent HIV infection in the event of exposure, the drug has also had a significant impact on various facets of sexuality. In this review, we focus on research that emerged in the near decade since PrEP's approval, with a specific focus on the ways in which different elements of sex and sexuality have been impacted by gay, bisexual, and other men who have sex with men (GBMSM), cisgender women, and transgender individuals. We highlight evidence showing how PrEP has enhanced sexual self-esteem, improved sexual pleasure, reduced sexual anxiety, and has increased sexual agency for those taking it. For many, PrEP also serves as a gateway to improve routine health and increase sexual health-care utilization. Additionally, we review the question of whether PrEP is associated with increased sexual risk taking (i.e. risk compensation), and note that, although some data are mixed, PrEP is not intended as an intervention to reduce condomless anal sex or STIs: it aims to prevent HIV. Finally, our review highlights that, although the volume of research on PrEP among GBMSM is robust, it is underdeveloped for cisgender women and transgender populations and insufficient for inclusion in such a review for cisgender heterosexual men was. PrEP research with these populations is an important direction for future research. Finally, from 2012 to 2019, a single PrEP formulation and delivery method was FDA approved (oral emtricitabine/tenofovir disoproxil fumarate). As additional drug formulations (ie.g., emtricitabine/tenofovir alafenamide) and delivery methods (e.g., microbiocides, vaginal ring, injectable) come to market, it will be important to examine how these, too, impact the spectrum of sexuality.
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Affiliation(s)
- Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | | | - Alexa B. D’Angelo
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | - David W. Pantalone
- Department of Psychology, University of Massachusetts Boston
- The Fenway Institute, Fenway Health, Boston, MA
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20
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Electronic Dissemination of a Web-Based Video Promotes PrEP Contemplation and Conversation Among US Women Engaged in Care at Planned Parenthood. AIDS Behav 2021; 25:2483-2500. [PMID: 33704618 PMCID: PMC7947376 DOI: 10.1007/s10461-021-03210-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/11/2022]
Abstract
We evaluated the acceptability and impact of a web-based PrEP educational video among women (n = 126) by comparing two Planned Parenthood centers: one assigned to a Web Video Condition and one to a Standard Condition. Most women reported the video helped them better understand what PrEP is (92%), how PrEP works (93%), and how to take PrEP (92%). One month post-intervention, more women in the Web Video Condition reported a high level of comfort discussing PrEP with a provider (82% vs. 48%) and commonly thinking about PrEP (36% vs. 4%). No women with linked medical records initiated PrEP during 1-year follow-up.
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21
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Craddock JB, Mangum LC, Aidoo-Frimpong G, Whitfield DL. The Associations of HIV Pre-Exposure Prophylaxis Interest and Sexual Risk Behaviors Among Young Black Women. AIDS Patient Care STDS 2021; 35:263-270. [PMID: 34242088 DOI: 10.1089/apc.2020.0259] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The uptake of pre-exposure prophylaxis (PrEP) is low among young Black cisgender heterosexual women, although this subgroup faces a higher burden of new HIV diagnoses. This study explored the association between sexual risk and prevention behaviors, and oral PrEP and vaginal PrEP ring interest among young Black women (YBW). A sample of YBW (N = 208) 18-25 years of age completed a self-administered questionnaire assessing sexual risk and prevention behaviors, HIV and sexually transmitted infection (STI) testing, and PrEP interest from June to December 2018. Results revealed that 103 YBW were interested in taking oral or vaginal PrEP, with 43% interested in oral PrEP use only, 28% interested in vaginal PrEP use only, and 29% interested in both oral and vaginal PrEP use. Logistic regressions revealed that YBW who had sex in the last 1-4 weeks or 3-6 months had lower odds of being interested in oral PrEP and YBW who had sex in the last 1-4 weeks had lower odds of being interested in vaginal PrEP compared with those whose last sexual encounter occurred in the last week. A large percentage of our sample was unaware of PrEP at the time of survey administration, but after learning about PrEP became more interested in potential PrEP use. This indicates that more education about the benefits of PrEP coupled with harm reduction counseling to lower their risk of STI and HIV infections is necessary to increase PrEP interest among YBW.
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Affiliation(s)
- Jaih B. Craddock
- School of Social Work, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - Laurenia C. Mangum
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gloria Aidoo-Frimpong
- School of Public Health and Health Professions, University of Buffalo, Buffalo, New York, USA
| | - Darren L. Whitfield
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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22
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D'Angelo AB, Davis Ewart LN, Koken J, Bimbi D, Brown JT, Grov C. Barriers and Facilitators to Pre-exposure Prophylaxis Uptake Among Black Women: A Qualitative Analysis Guided by a Socioecological Model. J Assoc Nurses AIDS Care 2021; 32:481-494. [PMID: 34171885 DOI: 10.1097/jnc.0000000000000241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Black women experience disparities in HIV incidence. Pre-exposure prophylaxis (PrEP) is a once-daily pill that can prevent HIV transmission. To enhance PrEP uptake among Black women, it is essential to examine their perceptions of PrEP. In 2018, 33 Black women in New York City completed interviews about their attitudes, knowledge, and perceived barriers and facilitators to PrEP use. Emergent themes were organized using a socioecological model. Participants identified barriers at the sociocultural level, including stigma, medical mistrust, and health care avoidance. At the community level, health care access issues and limited community knowledge were reported. Partner-level barriers included trust in partners and meaning attributed to PrEP use within the context of monogamy. Individual-level barriers included low perceived risk and concerns about PrEP's safety and efficacy. Our findings can inform future PrEP research with Black women, as well as PrEP implementation efforts aimed at increasing uptake among this population.
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Affiliation(s)
- Alexa B D'Angelo
- Alexa B. D'Angelo, MPH, is a Project Coordinator and PhD Student, CUNY Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, New York, New York, USA. Leah N. Davis Ewart, MPH, CHES, is a PhD Student, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA. Juline Koken, PhD, is an Associate Professor, Department of Health Sciences, LaGuardia Community College of CUNY, Long Island City, New York, USA. David Bimbi, PhD, is a Professor, Department of Health Sciences, LaGuardia Community College of CUNY, Long Island City, New York, USA. Justin T. Brown, PhD, MPH, is an Assistant Professor and Executive Director, Department of Health Sciences, The Center for LGBTQ Studies (CLAGS), LaGuardia Community College of CUNY, Long Island City, New York, USA. Christian Grov, PhD, MPH, is a Professor, Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
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23
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Bond KT, Chandler R, Chapman-Lambert C, Jemmott LS, Lanier Y, Cao J, Nikpour J, Randolph SD. Applying a Nursing Perspective to Address the Challenges Experienced by Cisgender Women in the HIV Status Neutral Care Continuum: A Review of the Literature. J Assoc Nurses AIDS Care 2021; 32:283-305. [PMID: 33929979 PMCID: PMC10688540 DOI: 10.1097/jnc.0000000000000243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The field of HIV research has grown over the past 40 years, but there remains an urgent need to address challenges that cisgender women living in the United States experience in the HIV neutral status care continuum, particularly among women such as Black women, who continue to be disproportionately burdened by HIV due to multiple levels of systemic oppression. We used a social ecological framework to provide a detailed review of the risk factors that drive the women's HIV epidemic. By presenting examples of effective approaches, best clinical practices, and identifying existing research gaps in three major categories (behavioral, biomedical, and structural), we provide an overview of the current state of research on HIV prevention among women. To illustrate a nursing viewpoint and take into account the diverse life experiences of women, we provide guidance to strengthen current HIV prevention programs. Future research should examine combined approaches for HIV prevention, and policies should be tailored to ensure that women receive effective services that are evidence-based and which they perceive as important to their lives.
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Affiliation(s)
- Keosha T Bond
- Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Rasheeta Chandler, PhD, RN, FNP-BC, FAANP, FAAN, is an Assistant Professor, School of Nursing, Emory University, Atlanta, Georgia, USA. Crystal Chapman-Lambert, PhD, CRNP, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Loretta Sweet Jemmott, PhD, RN, is Vice President, Health and Health Equity, and Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Yzette Lanier, PhD, is an Assistant Professor, School of Nursing, New York University, New York, New York, USA. Jiepin Cao, MS, RN, is a Graduate Student, School of Nursing, Duke University, Durham, North Carolina, USA. Jacqueline Nikpour, BSN, RN, is a Graduate Student, School of Nursing, Duke University, Durham, North Carolina, USA. Schenita D. Randolph, PhD, MPH, RN, CNE, is an Assistant Professor, School of Nursing, and Co-director, Community Engagement Core, Duke Center for Research to Advance Healthcare Equity (REACH Equity), Duke University, Durham, North Carolina, USA
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24
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Baldwin A, Light B, Allison WE. Pre-Exposure Prophylaxis (PrEP) for HIV Infection in Cisgender and Transgender Women in the U.S.: A Narrative Review of the Literature. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1713-1728. [PMID: 34075504 PMCID: PMC8213571 DOI: 10.1007/s10508-020-01903-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/18/2020] [Accepted: 12/09/2020] [Indexed: 05/11/2023]
Abstract
Using a socioecological approach, this review describes the peer-reviewed literature on oral pre-exposure prophylaxis (PrEP) among both cisgender (cis women) and transgender women (trans women) in the U.S. A search of the PubMed database and HIV-related conference abstracts generated over 2,200 articles and abstracts. Of these, 103 fulfilled review inclusion criteria. Most of the existing research presents findings on individual-level factors associated with PrEP use such as willingness and perceived barriers. There was far less investigation of factors related to PrEP at more distal ecological levels. Though trans women are at greater risk of HIV infection than cisgender women, less is known about this population group with respect to PrEP despite their inclusion in many major clinical trials. Further, the literature is characterized by a persistent conflation of sex and gender which makes it difficult to accurately assess the reviewed research on HIV prevention and PrEP apart from risk group. Informed by these findings, we highlight specific opportunities to improve access to PrEP and reduce socioecological barriers to PrEP care engagement for cisgender and transgender women.
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Affiliation(s)
- Aleta Baldwin
- Department of Public Health, California State University, Sacramento, Solano Hall 3014, 6000 J Street, Sacramento, CA, 95819, USA.
| | - Brenda Light
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Waridibo E Allison
- Division of Infectious Disease, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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25
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Threats M, Brawner BM, Montgomery TM, Abrams J, Jemmott LS, Crouch PC, Freeborn K, Kamitani E, Enah C. A Review of Recent HIV Prevention Interventions and Future Considerations for Nursing Science. J Assoc Nurses AIDS Care 2021; 32:373-391. [PMID: 33929980 PMCID: PMC8715511 DOI: 10.1097/jnc.0000000000000246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT As our knowledge of HIV evolved over the decades, so have the approaches taken to prevent its transmission. Public health scholars and practitioners have engaged in four key strategies for HIV prevention: behavioral-, technological-, biomedical-, and structural/community-level interventions. We reviewed recent literature in these areas to provide an overview of current advances in HIV prevention science in the United States. Building on classical approaches, current HIV prevention models leverage intimate partners, families, social media, emerging technologies, medication therapy, and policy modifications to effect change. Although much progress has been made, additional work is needed to achieve the national goal of ending the HIV epidemic by 2030. Nurses are in a prime position to advance HIV prevention science in partnership with transdisciplinary experts from other fields (e.g., psychology, informatics, and social work). Future considerations for nursing science include leveraging transdisciplinary collaborations and consider social and structural challenges for individual-level interventions.
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Affiliation(s)
- Megan Threats
- Megan Threats, PhD, MSLIS, is an Assistant Professor, School of Communication and Information, Rutgers University, New Brunswick, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA. Tiffany M. Montgomery, PhD, MSHP, RNC-OB, is a Postdoctoral Research Fellow, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Jasmine Abrams, PhD, is an Assistant Professor, Boston University School of Public Health, Boston, Massachusetts, USA. Loretta Sweet Jemmott, PhD, RN, FAAN, is a Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Pierre-Cedric Crouch, PhD, ANP-BC, ACRN, is Director, Community Health Solutions, San Francisco, California, USA. Kellie Freeborn, PhD, RN, ANP-BC, FNP-BC, is a Postdoctoral Fellow, Division of Global Women’s Health, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA. Emiko Kamitani, PhD, MPH, MS, RN, is a Professor by Special Appointment, Advanced Graduate Program for Future Medicine and Health Care, Tohoku University, Sendai, Japan. Comfort Enah, PhD, RN, FAAN, is an Associate Professor, Solomont School of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Bridgette M. Brawner
- Megan Threats, PhD, MSLIS, is an Assistant Professor, School of Communication and Information, Rutgers University, New Brunswick, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA. Tiffany M. Montgomery, PhD, MSHP, RNC-OB, is a Postdoctoral Research Fellow, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Jasmine Abrams, PhD, is an Assistant Professor, Boston University School of Public Health, Boston, Massachusetts, USA. Loretta Sweet Jemmott, PhD, RN, FAAN, is a Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Pierre-Cedric Crouch, PhD, ANP-BC, ACRN, is Director, Community Health Solutions, San Francisco, California, USA. Kellie Freeborn, PhD, RN, ANP-BC, FNP-BC, is a Postdoctoral Fellow, Division of Global Women’s Health, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA. Emiko Kamitani, PhD, MPH, MS, RN, is a Professor by Special Appointment, Advanced Graduate Program for Future Medicine and Health Care, Tohoku University, Sendai, Japan. Comfort Enah, PhD, RN, FAAN, is an Associate Professor, Solomont School of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Tiffany M. Montgomery
- Megan Threats, PhD, MSLIS, is an Assistant Professor, School of Communication and Information, Rutgers University, New Brunswick, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA. Tiffany M. Montgomery, PhD, MSHP, RNC-OB, is a Postdoctoral Research Fellow, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Jasmine Abrams, PhD, is an Assistant Professor, Boston University School of Public Health, Boston, Massachusetts, USA. Loretta Sweet Jemmott, PhD, RN, FAAN, is a Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Pierre-Cedric Crouch, PhD, ANP-BC, ACRN, is Director, Community Health Solutions, San Francisco, California, USA. Kellie Freeborn, PhD, RN, ANP-BC, FNP-BC, is a Postdoctoral Fellow, Division of Global Women’s Health, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA. Emiko Kamitani, PhD, MPH, MS, RN, is a Professor by Special Appointment, Advanced Graduate Program for Future Medicine and Health Care, Tohoku University, Sendai, Japan. Comfort Enah, PhD, RN, FAAN, is an Associate Professor, Solomont School of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Jasmine Abrams
- Megan Threats, PhD, MSLIS, is an Assistant Professor, School of Communication and Information, Rutgers University, New Brunswick, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA. Tiffany M. Montgomery, PhD, MSHP, RNC-OB, is a Postdoctoral Research Fellow, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Jasmine Abrams, PhD, is an Assistant Professor, Boston University School of Public Health, Boston, Massachusetts, USA. Loretta Sweet Jemmott, PhD, RN, FAAN, is a Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Pierre-Cedric Crouch, PhD, ANP-BC, ACRN, is Director, Community Health Solutions, San Francisco, California, USA. Kellie Freeborn, PhD, RN, ANP-BC, FNP-BC, is a Postdoctoral Fellow, Division of Global Women’s Health, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA. Emiko Kamitani, PhD, MPH, MS, RN, is a Professor by Special Appointment, Advanced Graduate Program for Future Medicine and Health Care, Tohoku University, Sendai, Japan. Comfort Enah, PhD, RN, FAAN, is an Associate Professor, Solomont School of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Loretta Sweet Jemmott
- Megan Threats, PhD, MSLIS, is an Assistant Professor, School of Communication and Information, Rutgers University, New Brunswick, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA. Tiffany M. Montgomery, PhD, MSHP, RNC-OB, is a Postdoctoral Research Fellow, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Jasmine Abrams, PhD, is an Assistant Professor, Boston University School of Public Health, Boston, Massachusetts, USA. Loretta Sweet Jemmott, PhD, RN, FAAN, is a Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Pierre-Cedric Crouch, PhD, ANP-BC, ACRN, is Director, Community Health Solutions, San Francisco, California, USA. Kellie Freeborn, PhD, RN, ANP-BC, FNP-BC, is a Postdoctoral Fellow, Division of Global Women’s Health, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA. Emiko Kamitani, PhD, MPH, MS, RN, is a Professor by Special Appointment, Advanced Graduate Program for Future Medicine and Health Care, Tohoku University, Sendai, Japan. Comfort Enah, PhD, RN, FAAN, is an Associate Professor, Solomont School of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Pierre-Cedric Crouch
- Megan Threats, PhD, MSLIS, is an Assistant Professor, School of Communication and Information, Rutgers University, New Brunswick, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA. Tiffany M. Montgomery, PhD, MSHP, RNC-OB, is a Postdoctoral Research Fellow, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Jasmine Abrams, PhD, is an Assistant Professor, Boston University School of Public Health, Boston, Massachusetts, USA. Loretta Sweet Jemmott, PhD, RN, FAAN, is a Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Pierre-Cedric Crouch, PhD, ANP-BC, ACRN, is Director, Community Health Solutions, San Francisco, California, USA. Kellie Freeborn, PhD, RN, ANP-BC, FNP-BC, is a Postdoctoral Fellow, Division of Global Women’s Health, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA. Emiko Kamitani, PhD, MPH, MS, RN, is a Professor by Special Appointment, Advanced Graduate Program for Future Medicine and Health Care, Tohoku University, Sendai, Japan. Comfort Enah, PhD, RN, FAAN, is an Associate Professor, Solomont School of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Kellie Freeborn
- Megan Threats, PhD, MSLIS, is an Assistant Professor, School of Communication and Information, Rutgers University, New Brunswick, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA. Tiffany M. Montgomery, PhD, MSHP, RNC-OB, is a Postdoctoral Research Fellow, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Jasmine Abrams, PhD, is an Assistant Professor, Boston University School of Public Health, Boston, Massachusetts, USA. Loretta Sweet Jemmott, PhD, RN, FAAN, is a Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Pierre-Cedric Crouch, PhD, ANP-BC, ACRN, is Director, Community Health Solutions, San Francisco, California, USA. Kellie Freeborn, PhD, RN, ANP-BC, FNP-BC, is a Postdoctoral Fellow, Division of Global Women’s Health, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA. Emiko Kamitani, PhD, MPH, MS, RN, is a Professor by Special Appointment, Advanced Graduate Program for Future Medicine and Health Care, Tohoku University, Sendai, Japan. Comfort Enah, PhD, RN, FAAN, is an Associate Professor, Solomont School of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Emiko Kamitani
- Megan Threats, PhD, MSLIS, is an Assistant Professor, School of Communication and Information, Rutgers University, New Brunswick, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA. Tiffany M. Montgomery, PhD, MSHP, RNC-OB, is a Postdoctoral Research Fellow, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Jasmine Abrams, PhD, is an Assistant Professor, Boston University School of Public Health, Boston, Massachusetts, USA. Loretta Sweet Jemmott, PhD, RN, FAAN, is a Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Pierre-Cedric Crouch, PhD, ANP-BC, ACRN, is Director, Community Health Solutions, San Francisco, California, USA. Kellie Freeborn, PhD, RN, ANP-BC, FNP-BC, is a Postdoctoral Fellow, Division of Global Women’s Health, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA. Emiko Kamitani, PhD, MPH, MS, RN, is a Professor by Special Appointment, Advanced Graduate Program for Future Medicine and Health Care, Tohoku University, Sendai, Japan. Comfort Enah, PhD, RN, FAAN, is an Associate Professor, Solomont School of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Comfort Enah
- Megan Threats, PhD, MSLIS, is an Assistant Professor, School of Communication and Information, Rutgers University, New Brunswick, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA. Tiffany M. Montgomery, PhD, MSHP, RNC-OB, is a Postdoctoral Research Fellow, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Jasmine Abrams, PhD, is an Assistant Professor, Boston University School of Public Health, Boston, Massachusetts, USA. Loretta Sweet Jemmott, PhD, RN, FAAN, is a Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Pierre-Cedric Crouch, PhD, ANP-BC, ACRN, is Director, Community Health Solutions, San Francisco, California, USA. Kellie Freeborn, PhD, RN, ANP-BC, FNP-BC, is a Postdoctoral Fellow, Division of Global Women’s Health, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA. Emiko Kamitani, PhD, MPH, MS, RN, is a Professor by Special Appointment, Advanced Graduate Program for Future Medicine and Health Care, Tohoku University, Sendai, Japan. Comfort Enah, PhD, RN, FAAN, is an Associate Professor, Solomont School of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Kimmel AL, Messersmith LJ, Bazzi AR, Sullivan MM, Boudreau J, Drainoni ML. Implementation of HIV pre-exposure prophylaxis for women of color: Perspectives from healthcare providers and staff from three clinical settings. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2021; 19:299-319. [PMID: 34456637 PMCID: PMC8386511 DOI: 10.1080/15381501.2021.1887038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/28/2020] [Accepted: 02/03/2021] [Indexed: 06/13/2023]
Abstract
Women of color (WOC) account for 83% of new HIV infections among women in the United States. While pre-exposure prophylaxis (PrEP) is a safe, effective HIV prevention method for women, WOC are less likely to be prescribed PrEP than other populations. Guided by an implementation science research framework, we investigated the implementation of a PrEP initiative for WOC in a US city with high HIV incidence. Across three clinical sites, only three WOC were prescribed PrEP after one year. Analysis of qualitative interviews with clinic staff and providers identified time constraints, reluctance to prescribe PrEP, and discomfort with counseling as implementation barriers. Implementation facilitators included staff and leadership support for PrEP, alignment of PrEP services with organizational missions, and having a centralized PrEP Coordinator. By addressing these identified implementation barriers and facilitators, clinic staff and providers can ensure that WOC are provided with the full range of HIV prevention options.
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Affiliation(s)
- Allison L. Kimmel
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Lisa J. Messersmith
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Angela R. Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | | | - Jacqueline Boudreau
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
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Troutman J. African American Women's Current Knowledge, Perceptions, and Willingness of PrEP Use for HIV Prevention in the South. JOURNAL OF HEALTHCARE, SCIENCE AND THE HUMANITIES 2021; 11:51-72. [PMID: 36818214 PMCID: PMC9930508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
African American women accounted for approximately 60% of new HIV diagnoses among women in the United States, with the greatest burden occurring in the South. Past efforts to prevent HIV focused on behavioral interventions aimed at reducing sexual risk behavior. More recent HIV prevention methods have included oral pre-exposure prophylaxis (PrEP) with antiretroviral drugs. Although PrEP has been designated as an effective HIV prevention method since 2012, awareness and uptake of PrEP remains low among African American women. Our study explored African American women's knowledge, perceptions, and willingness of PrEP use. Four focus groups were held in April 2019, consisting of 27 women, who identified as African American and resided in South Carolina. Focus group topics focused on participants' awareness, perceptions, and potential use of PrEP. The majority of women had heard of PrEP; however, over half of the participants were in the HIV or health field. Overall, participants believed that the "lay woman" would be unaware of PrEP. Participants' perceptions of PrEP included stigma of PrEP use, benefits to non-monogamous couples, and experiences with PrEP clients. The majority of women were willing to use PrEP, but major concerns around short and long-term side effects were expressed. Participants provided recommendations to improve PrEP uptake among African American women that included targeted campaigns and spokespersons. African American women are interested and supportive of PrEP use for HIV prevention in the South, where HIV rates remain highest. Past PrEP implementation efforts have not been relatable to African American women; therefore, awareness and uptake rates remain low. Future efforts to increase PrEP awareness and uptake among African American women should be relevant, and should provide comprehensive information on potential side effects, purpose of use, and eligibility criteria.
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Affiliation(s)
- Jamie Troutman
- Arnold School of Public Health, University of South Carolina, Department of Health Promotion, Education, and Behavior Discovery I, 915 Greene Street, Columbia, SC 29208, , ,
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Sewell WC, Patel RR, Blankenship S, Marcus JL, Krakower DS, Chan PA, Parker K. Associations Among HIV Risk Perception, Sexual Health Efficacy, and Intent to Use PrEP Among Women: An Application of the Risk Perception Attitude Framework. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:392-402. [PMID: 33112674 PMCID: PMC8049455 DOI: 10.1521/aeap.2020.32.5.392] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
HIV risk perception is a known determinant of HIV prevention behaviors among vulnerable populations. Lesser known is the combined influence of risk perception and efficacy beliefs on PrEP use. We examined the associations between levels of risk perception and strength of efficacy beliefs on intent to use PrEP in a sample of adult Black and Latina women. Guided by the risk perception attitudes (RPA) framework, we used cluster analysis to identify four interpretable groups. We ran analysis of covariance models to determine the relationship between membership in the RPA framework groups and intention to use PrEP. Among the 908 women, the mean age was 29.9 years and participants were Latina (69.4%) and Black (25.6%). Results of the analysis show that women with low perception of HIV risk and strong efficacy beliefs had significantly less intent to use PrEP than women with high risk perception and weak efficacy beliefs.
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Affiliation(s)
- Whitney C Sewell
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Rupa R Patel
- Washington University in St. Louis, St. Louis, Missouri
| | | | - Julia L Marcus
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Douglas S Krakower
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Pearson T, Chandler R, McCreary LL, Patil CL, McFarlin BL. Perceptions of African American Women and Health Care Professionals Related to Pre-Exposure Prophylaxis to Prevent HIV. J Obstet Gynecol Neonatal Nurs 2020; 49:571-580. [PMID: 32822648 DOI: 10.1016/j.jogn.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To describe the perceptions of African American women and health care professionals (HCPs) about factors that likely influence the use of pre-exposure prophylaxis (PrEP) to prevent HIV among African American women. DESIGN Prospective mixed methods. SETTING Chicago, IL. PARTICIPANTS Fifty-eight participants included HCPs (n = 10) and African American women (n = 48). METHODS Following the six steps of concept mapping, participants identified and rated factors they perceived to influence decisions to use PrEP among African American women. RESULTS African American women generated a list of statements, and we grouped the statements into eight clusters: access, financial, best benefits, protection, medication, setbacks, network, and fear. HCPs ranked having an HIV-positive partner as the most influential factor that affected African American women's decisions to use PrEP (network cluster). African American women ranked ability to prevent HIV when condom use cannot be negotiated as their top reason (best benefits cluster) for using PrEP. CONCLUSION African American women wanted to know how they could protect themselves and were open to using PrEP. For African American women considering the use of PrEP, the most influential factors were related to the benefits and accessibility of PrEP. HCPs should know that African American women are not afraid to discuss HIV risk and testing.
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Abrams JA, Tabaac A, Jung S, Else-Quest NM. Considerations for employing intersectionality in qualitative health research. Soc Sci Med 2020; 258:113138. [PMID: 32574889 PMCID: PMC7363589 DOI: 10.1016/j.socscimed.2020.113138] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/23/2020] [Accepted: 06/08/2020] [Indexed: 12/18/2022]
Abstract
Intersectionality theory has recently emerged in the health sciences as a critical theoretical and methodical approach. Though some scholars have outlined explicit guidelines for applying intersectionality in research using quantitative methods, others have cited epistemological concerns and additive thinking to advocate for the analysis of intersectionality with qualitative methods. Thus, there remains a need for additional guidance and support for utilizing and applying intersectionality theory throughout the qualitative research process. With the goal of demystifying the process of utilizing intersectionality as a methodological approach in qualitative research in the health sciences, this paper provides researchers with recommendations, specific examples, and important considerations for incorporating intersectional approaches into study conceptualization, participant recruitment, data collection, and data analysis. Additionally, this paper reviews challenges that researchers may experience in conducting research using intersectional approaches and offers suggestions for overcoming challenges. This paper offers timely and relevant information that can be used to strengthen the theoretical and methodological rigor of qualitative health research, especially studies that seek to advance health equity.
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Affiliation(s)
- Jasmine A Abrams
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
| | - Ariella Tabaac
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Jung
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Nicole M Else-Quest
- Department of Women and Gender Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Nakasone SE, Young I, Estcourt CS, Calliste J, Flowers P, Ridgway J, Shahmanesh M. Risk perception, safer sex practices and PrEP enthusiasm: barriers and facilitators to oral HIV pre-exposure prophylaxis in Black African and Black Caribbean women in the UK. Sex Transm Infect 2020; 96:349-354. [PMID: 32532928 PMCID: PMC7402557 DOI: 10.1136/sextrans-2020-054457] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/27/2020] [Accepted: 02/29/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES UK Black African/Black Caribbean women remain disproportionately affected by HIV. Although oral pre-exposure prophylaxis (PrEP) could offer them an effective HIV prevention method, uptake remains limited. This study examined barriers and facilitators to PrEP awareness and candidacy perceptions for Black African/Black Caribbean women to help inform PrEP programmes and service development. METHODS Using purposive sampling through community organisations, 32 in-depth, semi-structured interviews were conducted with Black African/Black Caribbean women living in London and Glasgow between June and August 2018. Participants (aged 19-63) included women of varied HIV statuses to explore perceptions of sexual risk and safer sex, sexual health knowledge and PrEP attitudes. A thematic analysis guided by the Social Ecological Model was used to explore how PrEP perceptions intersected with wider safer sex understandings and practices. RESULTS Four key levels of influence shaping safer sex notions and PrEP candidacy perceptions emerged: personal, interpersonal, perceived environment and policy. PrEP-specific knowledge was low and some expressed distrust in PrEP. Many women were enthusiastic about PrEP for others but did not situate PrEP within their own safer sex understandings, sometimes due to difficulty assessing their own HIV risk. Many felt that PrEP could undermine intimacy in their relationships by disrupting the shared responsibility implicit within other HIV prevention methods. Women described extensive interpersonal networks that supported their sexual health knowledge and shaped their interactions with health services, though these networks were influenced by prevailing community stigmas. CONCLUSIONS Difficulty situating PrEP within existing safer sex beliefs contributes to limited perceptions of personal PrEP candidacy. To increase PrEP uptake in UK Black African/Black Caribbean women, interventions will need to enable women to advance their knowledge of PrEP within the broader context of their sexual health and relationships. PrEP service models will need to include trusted 'non-sexual health-specific' community services such as general practice.
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Affiliation(s)
| | - Ingrid Young
- Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Claudia S Estcourt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Paul Flowers
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jessica Ridgway
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Maryam Shahmanesh
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, Durban, South Africa
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Chandler R, Hull S, Ross H, Guillaume D, Paul S, Dera N, Hernandez N. The pre-exposure prophylaxis (PrEP) consciousness of black college women and the perceived hesitancy of public health institutions to curtail HIV in black women. BMC Public Health 2020; 20:1172. [PMID: 32723313 PMCID: PMC7385954 DOI: 10.1186/s12889-020-09248-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 07/13/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Consistent use of Pre-Exposure Prophylaxis (PrEP), a biomedical intervention for HIV seronegative persons, has been shown to significantly decrease HIV acquisition. Black women are a viable population segment to consider for PrEP use as their HIV incidence is overwhelmingly higher than all other women groups. METHODS We developed and piloted a cultural- and age- appropriate PrEP education intervention to determine Black college women's: 1) perceptions of and receptivity to PrEP use; and 2) preferences for PrEP information delivery. RESULTS We recruited N = 43 Black college women. Most of our sample were sophomore and Juniors of whom identified as heterosexual (83%) and single (67%). Over 50% of young women had never been HIV tested and only 28% had been tested in the last 6 months; however, 100% of the women believed their HIV status was negative. Prior to participating in the study, most Black college women (67%) had not heard about PrEP and were unsure or apprehensive (72%) to initiate PrEP. The Black college women indicated that our educational intervention was extremely helpful (67%) for understanding and learning about PrEP. Post participating in our PrEP education module, regardless of delivery modality, participants reported being likely (62.55-70%) to initiate PrEP in the future. CONCLUSIONS Results indicate that Black college women would strongly consider PrEP when provided with basic knowledge, regardless of delivery modality. Participants also showed greater appreciation for in-person delivery and found it to be significantly more helpful and of greater quality for learning about PrEP; comprehension or perceived usefulness of PrEP-related content was relatively the same between groups. PrEP content delivery -- via in-person or online methods - is contingent on learning style and presentation. TRIAL REGISTRATION This study has been registered under the ISRCTN Registry as of July 6, 2020. The trial registration number is ISRCTN14792715 . This study was retrospectively registered.
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Affiliation(s)
- Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing (NHWSON), Emory University, 1520 Clifton Rd., NE, Atlanta, GA, 30322-4027, USA.
| | - Shawnika Hull
- George Washington University, Prevention and Community Health, 1918 F Street NW, Washington, D.C, 20052, USA
| | - Henry Ross
- University of Rochester, Center for Community Practice, 601 Elmwood Ave, Rochester, NY, 14627, USA
| | - Dominique Guillaume
- Nell Hodgson Woodruff School of Nursing (NHWSON), Emory University, 1520 Clifton Rd., NE, Atlanta, GA, 30322-4027, USA
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing (NHWSON), Emory University, 1520 Clifton Rd., NE, Atlanta, GA, 30322-4027, USA
| | - Nikita Dera
- Morehouse School of Medicine, Community Health and Preventive Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
| | - Natalie Hernandez
- Morehouse School of Medicine, Community Health and Preventive Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
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Willie TC, Kershaw TS, Blackstock O, Galvao RW, Safon CB, Tekeste M, Ogburn DF, Wilbourn B, Modrakovic D, Taggart T, Kaplan C, Caldwell A, Calabrese SK. Racial and ethnic differences in women's HIV risk and attitudes towards pre-exposure prophylaxis (PrEP) in the context of the substance use, violence, and depression syndemic. AIDS Care 2020; 33:219-228. [PMID: 32408837 DOI: 10.1080/09540121.2020.1762067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Women with syndemic conditions, i.e., two or more co-occurring epidemics, are at elevated risk for HIV acquisition and are therefore prime candidates for pre-exposure prophylaxis (PrEP). However, PrEP uptake remains low among women, especially among Black and Hispanic women. This study examined associations of syndemic conditions with PrEP attitudes and HIV risk among women, and the moderating effect of race and ethnicity. In 2017, 271 non-Hispanic Black, non-Hispanic White, and Hispanic, PrEP-eligible women engaged in care at Planned Parenthood in the northeastern region of the U.S. completed an online survey. Participants reported syndemic conditions (i.e., intimate partner violence, depression, substance use), PrEP attitudes (e.g., PrEP interest), HIV sexual risk (e.g., multiple male sexual partners), and sociodemographics. Structural equation modeling was used to examine the effects of syndemic conditions on PrEP attitudes and HIV risk, and the moderating effect of race and ethnicity. Women with more syndemic conditions had a higher odds of reporting multiple male sexual partners. Syndemic conditions were positively associated with PrEP attitudes for Hispanic women than non-Hispanic Black and White women. Women with syndemic conditions, particularly Hispanic women, may be receptive to interventions promoting PrEP.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Oni Blackstock
- New York City Department of Health & Mental Hygiene, New York, NY, USA
| | - Rachel W Galvao
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cara B Safon
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.,Department of Health Law, Policy, and Management, Boston University, Boston, MA, USA
| | - Mehrit Tekeste
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Damon F Ogburn
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brittany Wilbourn
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
| | - Djordje Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Tamara Taggart
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.,Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Clair Kaplan
- Planned Parenthood of Southern New England, New Haven, CT, USA
| | | | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA.,Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Bond KT, Ramos SR. Utilization of an Animated Electronic Health Video to Increase Knowledge of Post- and Pre-Exposure Prophylaxis for HIV Among African American Women: Nationwide Cross-Sectional Survey. JMIR Form Res 2019; 3:e9995. [PMID: 31144667 PMCID: PMC6658301 DOI: 10.2196/formative.9995] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/30/2018] [Accepted: 04/29/2019] [Indexed: 11/25/2022] Open
Abstract
Background Despite renewed focus on biomedical prevention strategies since the publication of several clinical trials highlighting the efficacy of pre-exposure prophylaxis (PrEP), knowledge of postexposure prophylaxis (PEP) and PrEP continues to remain scarce among women, especially among African American women who are disproportionally affected by HIV. In an effort to address this barrier and encourage uptake of PEP and PrEP, an electronic health (eHealth) video was created using an entertainment-education format. Objective The study aimed to explore the feasibility, acceptability, and preference of an avatar-led, eHealth video, PEP and PrEP for Women, to increase awareness and knowledge of PEP and PrEP for HIV in a sample of African American women. Methods A cross-sectional, Web-based study was conducted with 116 African American women aged 18 to 61 years to measure participants’ perceived acceptability of the video on a 5-point scale: poor, fair, good, very good, and excellent. Backward stepwise regression was used to the find the outcome variable of a higher rating of the PEP and PrEP for Women video. Thematic analysis was conducted to explore the reasons for recommending the video to others after watching the eHealth video. Results Overall, 89% of the participants rated the video as good or higher. A higher rating of the educational video was significantly predicted by: no current use of drugs/alcohol (beta=−.814; P=.004), not having unprotected sex in the last 3 months (beta=−.488; P=.03), higher income (beta=.149; P=.03), lower level of education (beta=−.267; P=.005), and lower exposure to sexual assault since the age of 18 years (beta=−.313; P=.004). After watching the eHealth video, reasons for recommending the video included the video being educational, entertaining, and suitable for women. Conclusions Utilization of an avatar-led eHealth video fostered education about PEP and PrEP among African American women who have experienced insufficient outreach for biomedical HIV strategies. This approach can be leveraged to increase awareness and usage among African American women.
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Affiliation(s)
- Keosha T Bond
- Department of Public Health, New York Medical College, Valhalla, NY, United States
| | - S Raquel Ramos
- Rory Meyers College of Nursing, New York University, New York, NY, United States
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35
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Park CJ, Taylor TN, Gutierrez NR, Zingman BS, Blackstock OJ. Pathways to HIV Pre-exposure Prophylaxis Among Women Prescribed PrEP at an Urban Sexual Health Clinic. J Assoc Nurses AIDS Care 2019; 30:321-329. [PMID: 30958408 DOI: 10.1097/jnc.0000000000000070] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Little is known about real-world facilitators of and barriers to pre-exposure prophylaxis (PrEP) uptake among women prescribed PrEP. We sought to characterize the pathway to PrEP uptake and continuation in women prescribed PrEP at an urban sexual health-focused clinic. We conducted semi-structured individual interviews with 14 women from October 2016 to May 2017. Using grounded theory and the constant comparative method, we found that self-perceived HIV risk, learning about PrEP through trusted sources, having positive interactions with PrEP providers, and insurance coverage were facilitators of PrEP uptake and continuation. Concerns about PrEP safety, misinformation about PrEP eligibility and appropriateness, lack of insurance coverage, and pharmacy impediments were key barriers. The confluence of these issues led to PrEP rumination, a process of ongoing deliberation about the benefits and risks of PrEP. These findings provide important insights about how to increase PrEP uptake among women at high risk of HIV infection.
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Affiliation(s)
- Connie J Park
- Connie J. Park, MD, is an Assistant Professor of Medicine, Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA. Tonya N. Taylor, PhD, MS, is an Assistant Professor of Medicine, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA. Nataly Rios Gutierrez, BA, is a Study Coordinator, Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA. Barry S. Zingman, MD, is a Professor of Medicine, Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA. Oni J. Blackstock, MD, MHS, is an Assistant Professor of Medicine, Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
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36
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Calabrese SK, Earnshaw VA, Underhill K, Krakower DS, Magnus M, Hansen NB, Mayer KH, Betancourt JR, Kershaw TS, Dovidio JF. Prevention paradox: Medical students are less inclined to prescribe HIV pre-exposure prophylaxis for patients in highest need. J Int AIDS Soc 2018; 21:e25147. [PMID: 29939488 PMCID: PMC6016621 DOI: 10.1002/jia2.25147] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/22/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Despite healthcare providers' growing awareness of pre-exposure prophylaxis (PrEP), prescription rates remain low. PrEP is an efficacious HIV prevention strategy recommended for use with condoms but still protective in their absence. Concern about the impact of PrEP on condom use and other risk behaviour is, nonetheless, among the barriers to prescription commonly reported. To understand the implications of this concern for PrEP access, we examined how medical students' willingness to prescribe PrEP varied by patients' condom use and partnering practices. We also assessed the perceived acceptability of various reasons for condom discontinuation with PrEP. METHODS An online survey was distributed to 854 medical students in the Northeastern US in 2015. Participants (n = 111) were surveyed about their willingness to prescribe PrEP for each of six male patients who systematically differed in their reported condom use (sustained use, sustained nonuse, or discontinuation with PrEP) and partnering practices (single male partner with untreated HIV or multiple male partners of unknown HIV status). Participants also reported perceived acceptability of four reasons for condom discontinuation: pleasure, sexual functioning, intimacy, and conception. RESULTS Willingness to prescribe PrEP was inconsistent with patient risk: When the patient used condoms and planned to sustain condom use, most participants were willing to prescribe PrEP - 93% if the patient had a single partner and 86% if the patient had multiple partners. Fewer were willing to prescribe if the patient did not use condoms and planned to sustain nonuse (53% and 45%, respectively) or used condoms but planned to discontinue use (27% and 28%). Significantly fewer participants were willing to prescribe for a patient with multiple partners versus a single partner when the patient reported sustained condom use or sustained condom nonuse. The number of participants who were willing to prescribe was similarly low for a patient with multiple partners versus a single partner when the patient reported that he planned to discontinue condom use. More participants accepted a patient discontinuing condoms for conception (69%) than for intimacy (23%), pleasure (14%), or sexual functioning (13%). CONCLUSION Medical students' clinical judgments were misaligned with patient risk and suggest misconceptions or personal values may undermine provision of optimal HIV prevention services.
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Affiliation(s)
- Sarah K Calabrese
- Department of PsychologyGeorge Washington UniversityWashingtonDCUSA
- Social and Behavioral Sciences DepartmentYale School of Public HealthYale UniversityNew HavenCTUSA
| | - Valerie A Earnshaw
- Department of Human Development and Family StudiesUniversity of DelawareNewarkDEUSA
| | - Kristen Underhill
- Columbia Law SchoolColumbia UniversityNew YorkNYUSA
- Heilbrunn Department of Population & Family HealthMailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Douglas S Krakower
- The Fenway InstituteFenway HealthBostonMAUSA
- Beth Israel Deaconess Medical CenterHarvard Medical SchoolHarvard UniversityBostonMAUSA
- Department of Population MedicineHarvard Medical SchoolHarvard UniversityBostonMAUSA
| | - Manya Magnus
- Department of Epidemiology and BiostatisticsMilken Institute School of Public HealthGeorge Washington UniversityWashingtonDCUSA
| | - Nathan B Hansen
- Department of Health Promotion and BehaviorCollege of Public HealthUniversity of GeorgiaAthensGAUSA
| | - Kenneth H Mayer
- The Fenway InstituteFenway HealthBostonMAUSA
- Beth Israel Deaconess Medical CenterHarvard Medical SchoolHarvard UniversityBostonMAUSA
- Department of Global Health and PopulationHarvard TH Chan School of Public HealthHarvard UniversityBostonMAUSA
| | - Joseph R Betancourt
- Disparities Solutions CenterMassachusetts General HospitalHarvard Medical SchoolHarvard UniversityBostonMAUSA
| | - Trace S Kershaw
- Social and Behavioral Sciences DepartmentYale School of Public HealthYale UniversityNew HavenCTUSA
| | - John F Dovidio
- Social and Behavioral Sciences DepartmentYale School of Public HealthYale UniversityNew HavenCTUSA
- Department of PsychologyYale UniversityNew HavenCTUSA
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