Let Me Prep You to PREP Me: Amplifying the Voices of Black Women and Their Providers to Consider PrEP as an HIV Prevention Option
Abstract
:1. Introduction
2. Materials and Methods
2.1. Parent Study: Savvy HER
2.2. Setting and Eligibility Criteria
2.3. Study Procedures
3. Results
3.1. Demographics
3.2. PrEP Awareness, Knowledge, and Acceptability—Black Cisgender Women
“I am kind of scared to take pills because of the side effects…. you take this because it is supposed to help you get well, but it is actually like killing you on the inside.”—18-year-old participant who is single.
“No [I would not take it if offered] it is just …something I would not use…at first I thought it was strictly for homosexuals.”—18-year-old participant who is six months postpartum.
“I know a lot of times women get [HIV] from their boyfriends or husband because he has been sleeping around so I think it would be good for someone who is in a committed relationship and they think or they know that their partner is a cheater and has cheated before. I think it would be something good for them in case they decide to continue that relationship and have unprotected sex with that person.”—30-year-old participant who is single and employed full-time.
“Mmm I mean if I considered myself high risk [for HIV] then possibly [ I would consider using PrEP], but I am pretty low risk I believe um I am a one partner type of person and I pretty much have been in a long-term monogamous relationship…”—27-year-old woman who is 4 weeks postpartum.
3.3. Sources of Information and Lack of Representation—Black Cisgender Women
“When I see the commercial that is why I said I did not know if I needed to have it [PrEP]… because the commercial kind of gives that [impression], you know, I believe it is a transgender then it is a gay male commercial. So, it is showing the [who] the commercials geared towards. So that is why I was like, ‘do I have to have HIV to get it?’ Or is it ‘No, I do not need to have HIV and I can take it.’…the commercial does give the impression that it is not for the heterosexual community.”—24-year-old woman who is living with their partner.
3.4. Perceptions of PrEP—Healthcare Staff
“No [clients would not be interested in taking PrEP] based on [my experience] completing STD screening, which includes an evaluation for PrEP qualifications. They meet the qualifications for PrEP [uptake]. Some females take it but not that many. I would say, out of my years working here, every guy has declined PrEP, unless they were an MSM, and as for the females, the majority of them did not want it.”—Health Care Provider.
3.5. Barriers to PrEP Use—Healthcare Staff
“PrEP sounds great, but when the client calls me in need, sure I can write your prescription but is $3000 per month worth it? or I do not know if it is that much but you know, thousands of dollars. That is not feasible, so if we had a program where to fund the medication that would be great.”—Health Care Provider.
“I have clients that are now naturalists and think birth control is bad and condoms knock off your pH balance and things like that. I do always talk about [PrEP] and most of the time they have not heard of it or they think it is for gay people…well gay men. So, I have to let them know that it prevents HIV.”—Health Care Provider.
“I just wish there was a better infrastructure at the clinic to offer PrEP …I feel bad offering women PrEP and then sending them elsewhere to get PrEP….”—Family Support Worker.
4. Discussion
PrEP Savvy Features for Promotion of PrEP Uptake
5. Conclusions
Limitations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Hirschhorn, L.R.; Brown, R.N.; Friedman, E.E.; Greene, G.J.; Bender, A.; Christeller, C.; Bouris, A.; Johnson, A.K.; Pickett, J.; Modali, L.; et al. Black Cisgender Women’s PrEP Knowledge, Attitudes, Preferences, and Experience in Chicago. J. Acquir. Immune Defic. Syndr. 2020, 84, 497–507. [Google Scholar] [CrossRef] [PubMed]
- National Institutes of Health (NIH). NIH Celebrates FDA Approval of Long-Acting Injectable Drug for HIV Prevention. Available online: https://www.nih.gov/news-events/news-releases/nih-celebrates-fda-approval-long-acting-injectable-drug-hiv-prevention (accessed on 28 December 2021).
- CDC Geographic Distribution. Statistics Overview|Statistics Center|HIV/AIDS|CDC. Available online: https://www.cdc.gov/hiv/statistics/overview/geographicdistribution.html (accessed on 28 December 2021).
- Sales, J.M.; Steiner, R.J.; Brown, J.L.; Swartzendruber, A.; Patel, A.S.; Sheth, A.N. PrEP Eligibility and Interest Among Clinic- and Community-Recruited Young Black Women in Atlanta, Georgia, USA. Curr. HIV Res. 2018, 16, 250. [Google Scholar] [CrossRef] [PubMed]
- United States Census Bureau. U.S. Census Bureau QuickFacts: Atlanta City, Georgia. Available online: https://www.census.gov/quickfacts/atlantacitygeorgia (accessed on 28 December 2021).
- Georgia Department of Public Health HIV/AIDS Case Surveillance|Georgia Department of Public Health. Available online: https://dph.georgia.gov/epidemiology/georgias-hivaids-epidemiology-section/hivaids-case-surveillance#CaseSurveillanceCurrentData (accessed on 28 December 2021).
- Beyrer, C.; Bekker, L.G.; Pozniak, A.; Barré-Sinoussi, F. Pre-exposure prophylaxis works—It’s time to deliver. Lancet 2015, 385, 1482–1484. [Google Scholar] [CrossRef]
- Lancaster, K.E.; Lungu, T.; Bula, A.; Shea, J.M.; Shoben, A.; Hosseinipour, M.C.; Kohler, R.E.; Hoffman, I.F.; Go, V.F.; Golin, C.E.; et al. Preferences for Pre-exposure Prophylaxis Service Delivery Among Female Sex Workers in Malawi: A Discrete Choice Experiment. AIDS Behav. 2020, 24, 1294–1303. [Google Scholar] [CrossRef]
- Kaiser Family Foundation Women and HIV in the United States|KFF. Available online: https://www.kff.org/hivaids/fact-sheet/women-and-hivaids-in-the-united-states/ (accessed on 10 August 2021).
- 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. [Google Scholar] [CrossRef]
- CDC HIV Surveillance|Reports|Resource Library|HIV/AIDS|CDC. 2018. Available online: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2018-updated-vol-31.pdf. (accessed on 24 November 2021).
- Hill, B.S.; Patel, V.V.; Haughton, L.J.; Blackstock, O.J. Leveraging Social Media to Explore Black Women’s Perspectives on HIV Pre-exposure Prophylaxis. J. Assoc. Nurses AIDS Care 2018, 29, 107–114. [Google Scholar] [CrossRef] [Green Version]
- Chittamuru, D.; Frye, V.; Koblin, B.A.; Brawner, B.; Tieu, H.-V.; Davis, A.; Teitelman, A.M. PrEP stigma, HIV stigma, and intention to use PrEP among women in New York City and Philadelphia. Stigma Health 2020, 5, 240–246. [Google Scholar] [CrossRef]
- Liu, A.; Vittinghoff, E.; Von Felten, P.; Amico, R.; Anderson, P.; Lester, R.; Andrew, E.; Serrano, P.; Estes, I.; Balthazar, C.; et al. Prep initiation and early adherence among young MSM and transgender women in Chicago in the enhancing PrEP in community (EPIC) study. AIDS Res. Hum. Retrovir. 2016, 32, 81. [Google Scholar] [CrossRef]
- Ridgway, J.; Almirol, E.; Schmitt, J.; Bender, A.; Anderson, G.; Leroux, I.; Mcnulty, M.; Schneider, J. Exploring gender differences in prep interest among individuals testing hiv negative in an urban emergency department. AIDS Educ. Prev. 2019, 30, 382–392. [Google Scholar] [CrossRef]
- Mullins, T.L.K.; Zimet, G.; Lally, M.; Xu, J.; Thornton, S.; Kahn, J.A. HIV Care Providers’ Intentions to Prescribe and Actual Prescription of Pre-Exposure Prophylaxis to At-Risk Adolescents and Adults. AIDS Patient Care STDs 2017, 31, 504–516. [Google Scholar] [CrossRef]
- Karris, M.Y.; Beekmann, S.E.; Mehta, S.R.; Anderson, C.M.; Polgreen, P.M. Are we prepped for preexposure prophylaxis (PrEP)? Provider opinions on the real-world use of PrEP in the United States and Canada. Clin. Infect. Dis. 2014, 58, 704–712. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Pearson, T.; Chandler, R.; McCreary, L.L.; Patil, C.L.; McFarlin, B.L. 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. [Google Scholar] [CrossRef] [PubMed]
- Dale, S.K. Using Motivational Interviewing to Increase PrEP Uptake among Black Women at Risk for HIV: An Open Pilot Trial of MI-PrEP. J. Racial Ethn. Health Disparities 2020, 7, 913–927. [Google Scholar] [CrossRef] [PubMed]
- Seidman, D.; Carlson, K.; Weber, S.; Witt, J.; Kelly, P.J. United States family planning providers’ knowledge of and attitudes towards preexposure prophylaxis for HIV prevention: A national survey. Contraception 2016, 93, 463–469. [Google Scholar] [CrossRef] [PubMed]
- Conner, M. Social Cognitive Theory-An overview|ScienceDirect Topics. In International Encyclopedia of the Social & Behavioral Sciences, 2nd ed.; Elsevier: Amsterdam, The Netherlands, 2015; pp. 582–587. [Google Scholar]
- Saldana, J. An Introduction to Codes and Coding. In The Coding Manual for Qualitative Researchers; SAGE Publications Inc.: Thousand Oaks, CA, USA, 2009; pp. 3–12. [Google Scholar]
- Given, L. Thematic Coding and Analysis. In The SAGE Encyclopedia of Qualitative Research Methods; SAGE Publications, Inc.: Thousand Oaks, CA, USA, 2012. [Google Scholar]
- Ojikutu, B.O.; Mayer, K. HIV Prevention among Black Women in the US—Time for Multimodal Integrated Strategies. JAMA Netw. Open 2021, 4, e215356. [Google Scholar] [CrossRef] [PubMed]
- Pleuhs, B.; Quinn, K.G.; Walsh, J.L.; Petroll, A.E.; John, S.A. Health Care Provider Barriers to HIV Pre-Exposure Prophylaxis in the United States: A Systematic Review. AIDS Patient Care STDS 2020, 34, 111. [Google Scholar] [CrossRef] [Green Version]
- Flash, C.A.; Stone, V.E.; Mitty, J.A.; Mimiaga, M.J.; Hall, K.T.; Krakower, D.; Mayer, K.H. Perspectives on HIV prevention among urban black women: A potential role for HIV pre-exposure prophylaxis. AIDS Patient Care STDS 2014, 28, 635–642. [Google Scholar] [CrossRef]
- Eaton, L.A.; Kalichman, S.C.; Price, D.; Finneran, S.; Allen, A.; Maksut, J. Stigma and Conspiracy Beliefs Related to Pre-exposure Prophylaxis (PrEP) and Interest in Using PrEP among Black and White Men and Transgender Women Who Have Sex with Men. AIDS Behav. 2017, 21, 1236. [Google Scholar] [CrossRef] [Green Version]
- Chapman Lambert, C.; Marrazzo, J.; Amico, K.R.; Mugavero, M.J.; Elopre, L. PrEParing Women to Prevent HIV: An Integrated Theoretical Framework to PrEP Black Women in the United States. J. Assoc. Nurses AIDS Care 2018, 29, 835–848. [Google Scholar] [CrossRef]
- Bond, K.T.; Gunn, A.J. Perceived Advantages and Disadvantages of Using Pre-Exposure Prophylaxis (PrEP) among Sexually Active Black Women: An Exploratory Study. J. Black Sex. Relatsh. 2016, 3, 1–24. [Google Scholar] [CrossRef]
- Cernasev, A.; Walker, C.; Armstrong, D.; Golden, J. Changing the PrEP Narrative: A Call to Action to Increase PrEP Uptake among Women. Women 2021, 1, 120–127. [Google Scholar] [CrossRef]
- Auerbach, J.D.; Kinsky, S.; Brown, G.; Charles, V. Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among us women at risk of acquiring HIV. AIDS Patient Care STDS 2015, 29, 102–110. [Google Scholar] [CrossRef] [PubMed]
- Mayer, K.H.; Agwu, A.; Malebranche, D. Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review. Adv. Ther. 2020, 37, 1778–1811. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Amico, K.R.; Ramirez, C.; Caplan, M.R.; Montgomery, B.E.; Stewart, J.; Hodder, S.; Swaminathan, S.; Wang, J.; Darden-Tabb, N.Y.; McCauley, M.; et al. Perspectives of US women participating in a candidate PrEP study: Adherence, acceptability and future use intentions. J. Int. AIDS Soc. 2019, 22, e25247. [Google Scholar] [CrossRef]
- Bailey, J.L.; Molino, S.T.; Vega, A.D.; Badowski, M. A Review of HIV Pre-Exposure Prophylaxis: The Female Perspective. Infect. Dis. Ther. 2017, 6, 363–382. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wingood, G.M.; Dunkle, K.; Camp, C.; Patel, S.; Painter, J.E.; Rubtsova, A.; DiClemente, R.J. Racial differences and correlates of potential adoption of preexposure prophylaxis: Results of a national survey. J. Acquir. Immune Defic. Syndr. 2013, 63, S95–S101. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kimmel, A.L.; Messersmith, L.J.; Bazzi, A.R.; Sullivan, M.M.; Boudreau, J.; Drainoni, M.L. Implementation of HIV pre-exposure prophylaxis for women of color: Perspectives from healthcare providers and staff from three clinical settings. J. HIV. AIDS. Soc. Serv. 2021, 19, 299. [Google Scholar] [CrossRef]
- Sales, J.M.; Escoffery, C.; Hussen, S.A.; Haddad, L.B.; McCumber, M.; Kwiatkowski, E.; Filipowicz, T.; Sanchez, M.; Psioda, M.A.; Sheth, A.N. Pre-exposure Prophylaxis Implementation in Family Planning Services Across the Southern United States: Findings from a Survey Among Staff, Providers and Administrators Working in Title X-Funded Clinics. AIDS Behav. 2021, 25, 1901–1912. [Google Scholar] [CrossRef]
- Bradley, E.; Forsberg, K.; Betts, J.E.; Deluca, J.B.; Kamitani, E.; Porter, S.E.; Sipe, T.A.; Hoover, K.W. Factors Affecting Pre-Exposure Prophylaxis Implementation for Women in the United States: A Systematic Review. J. Women’s Health (Larchmt.) 2019, 28, 1272–1285. [Google Scholar] [CrossRef]
- Kay, E.S.; Pinto, R.M. Is insurance a barrier to HIV preexposure prophylaxis? Clarifying the issue. Am. J. Public Health 2020, 110, 61–64. [Google Scholar] [CrossRef]
- NPR. The Feds Are Making PrEP Free. But You May Still Have to Pay to Get It: NPR. Available online: https://www.npr.org/2021/07/29/1022255279/feds-are-making-hiv-prevention-treatment-free (accessed on 9 November 2021).
- U.S. News and World Report PrEP HIV Prevention Pills to Be Free for Insured Americans|Health News|US News. Available online: https://www.usnews.com/news/health-news/articles/2021-07-21/prep-hiv-prevention-pills-to-be-free-for-insured-americans (accessed on 9 November 2021).
- Chandler, R.; Hernandez, N.; Guillaume, D.; Grandoit, S.; Branch-Ellis, D.; Lightfoot, M. A Community-Engaged Approach to Creating a Mobile HIV Prevention App for Black Women: Focus Group Study to Determine Preferences via Prototype Demos. JMIR mHealth uHealth 2020, 8, e18437. [Google Scholar] [CrossRef]
- Chandler, R.; Canty-Mitchell, J.; Kip, K.E.; Daley, E.M.; Morrison-Beedy, D.; Anstey, E.; Ross, H. College women’s preferred HIV prevention message mediums: Mass media versus interpersonal relationships. J. Assoc. Nurses AIDS Care 2013, 24, 491–502. [Google Scholar] [CrossRef] [PubMed]
- Phillips, G.; Raman, A.B.; Felt, D.; McCuskey, D.J.; Hayford, C.S.; Pickett, J.; Lindeman, P.T.; Mustanski, B. PrEP4Love: The Role of Messaging and Prevention Advocacy in PrEP Attitudes, Perceptions, and Uptake Among YMSM and Transgender Women. J. Acquir. Immune Defic. Syndr. 2020, 83, 450. [Google Scholar] [CrossRef] [PubMed]
- Thomas, K. A Better Life for Some: The Lovelife Campaign and HIV/AIDS in South Africa on JSTOR. Sex. Afr. 2004, 2, 29–35. [Google Scholar]
- Noar, S.M.; Palmgreen, P.; Chabot, M.; Dobransky, N.; Zimmerman, R.S. A 10-year systematic review of HIV/AIDS mass communication campaigns: Have we made progress? J. Health Commun. 2009, 14, 15–42. [Google Scholar] [CrossRef] [PubMed]
- Creel, A.H.; Rimal, R.N.; Mkandawire, G.; Böse, K.; Brown, J.W. Effects of a mass media intervention on HIV-related stigma: “Radio Diaries” program in Malawi. Health Educ. Res. 2011, 26, 456–465. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Caldwell, K.; Mathews, A. The Role of Relationship Type, Risk Perception, and Condom Use in Middle Socioeconomic Status Black Women’s HIV-prevention Strategies. J. Black Sex. Relatsh. 2015, 2, 91. [Google Scholar] [CrossRef] [Green Version]
- Kyomugisha, F.G. HIV, African American women, and high risk in heterosexual relationships. J. Afr. Am. Stud. 2013, 10, 38–50. [Google Scholar] [CrossRef]
- El-Bassel, N.; Caldeira, N.A.; Ruglass, L.M.; Gilbert, L. Addressing the unique needs of African American women in HIV prevention. Am. J. Public Health 2009, 99, 996–1001. [Google Scholar] [CrossRef]
Domain | Theme | Quote | Participant Characteristics |
---|---|---|---|
Barriers to PrEP uptake | |||
Low acceptability | “Um, no [I would not take it if offered] and the only reason why I say that is because I do not know enough about the medication.” | 24-year-old participant in a relationship | |
Risk perception | “It is not really something I have thought about…because I do not have sex….I think it has been like four years for me.” | 28 year-old single woman who is employed full time | |
Side effect concerns | “I am kind of scared to take pills because of the side effects…. you take this because it is supposed to help you get well, but it is actually like killing you on the inside.” | 18-year-old participant who is single | |
Low Knowledge | “How does that pill work? is that for people who have an STD?” | 18-year-old participant who is single and sexually active | |
Facilitators to PrEP uptake | |||
High Knowledge | “I actually did a report on it [PrEP] yesterday for my class, and I feel that the way that it is presented is actually very good and it is accurate… if it were to be offered, if that was something that I needed, I would definitely use it.” | 18-year-old participant who is in college full-time | |
High acceptability | “Yes, I would use it…I must say it is definitely used for HIV, which is common among in Black women, so I think that would be good for a woman to protect herself.” | 19-year-old participant who is single and is a full-time college student | |
Risk perception | “If I felt like I was being intimate with someone who had HIV, then yes I would most definitely want to take the pill.” | 22-year-old woman who is living with their partner | |
Representation of PrEP in the Media | |||
LGBTQ Drug | “The way that they present [PrEP] is more as a LGBT type drug and it automatically makes someone who is heterosexual say no I do not need that, it is not for me.” | 24-year-old single and employed full-time | |
Promiscuity | “With the commercials I think it is something good for people who are promiscuous, or I guess free spirited …something good for them to use...people who have more [partners] or who do different stuff…” | 30-year-old woman who is single and employed full-time |
Domain | Theme | Quote | Participant Characteristics |
---|---|---|---|
Patient barriers to PrEP uptake | |||
Low Patient Acceptability | “Well, when we first offered PrEP in [another Atlanta-based clinic] the manager told us ‘Hey, we will have this talk [with patients] about it’. [However]. They are not super, excited about even discussing [PrEP]. I can barely get women to use condoms.” | Family Support Worker | |
Challenges in uptake of sexual and reproductive health prevention methods | “Black women are a group we want to help make sure we provide sensitive care to, but at the same time, women do not use condoms very much…so to be like ‘hey do you want to use PrEP’ I feel like that is another hurdle [for sexual health prevention]. I have a hard time getting women to use contraception.” | Family Support Worker | |
Cost Barriers | “If PrEP were offered at no cost that would be great. But definitely at a reduced price…it is expensive. I forgot how much…but it was a lot…so um, yeah for free. It would be very helpful for the ladies.” | Health Care Provider | |
Stigma | “The race and stigma behind PrEP, alongside keeping clients interested is something [to consider].” | Health Care Provider | |
LGBTQ Drug | “PrEP would be very helpful for the ladies. Outside of the price being a barrier, yeah, the stigma behind PrEP is a barrier… it seen as a ‘gay man’s pill’…” | Health Care Provider | |
Provider barriers to providing PrEP | |||
Discomfort managing patients on PrEP | “I myself am kind of hesitant to manage a patient on PrEP.” | Health Care Provider | |
Costs | “I know PrEP is expensive if it was at a reduced price or no cost that would be great.” | Family Support Worker | |
Facilitators to PrEP uptake | |||
Provider acceptability | “Yeah. So, I think this population would highly benefit from it. I think it is a myth to kind of think that this population is scared of it. I think we inform these patients of the benefits of it and have them make the decision” | Family Support Worker | |
High Patient acceptability | “Honestly, we probably have more interest [women] in starting and maintaining PrEP than those who are not interested.” | Family Support Worker |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
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. Int. J. Environ. Res. Public Health 2022, 19, 1414. https://doi.org/10.3390/ijerph19031414
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(3):1414. https://doi.org/10.3390/ijerph19031414
Chicago/Turabian StyleChandler, Rasheeta, Dominique Guillaume, Jessica Wells, and Natalie Hernandez. 2022. "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 19, no. 3: 1414. https://doi.org/10.3390/ijerph19031414