The HIV/AIDS epidemic in the US continues to persist, in particular, among race, sexual orientation, and gender minority populations. Pre-exposure prophylaxis (PrEP), or using antiretroviral medications for HIV prevention, is an effective option, but uptake of PrEP has been slow. Sociocultural barriers to using PrEP have been largely underemphasized, yet have the potential to stall uptake and, therefore, warrant further understanding. In order to assess the relationships between potential barriers to PrEP (i.e., PrEP stigma and conspiracy beliefs), and interest in PrEP, Black men and transgender women who have sex with men (BMTW, N = 85) and White MTW (WMTW, N = 179) were surveyed at a gay pride event in 2015 in a large southeastern US city. Bivariate and multivariate logistic regression analyses were completed to examine factors associated with PrEP interest. Among the full sample, moderate levels of PrEP awareness (63%) and low levels of use (9%) were observed. Believing that PrEP is for people who are promiscuous (stigma belief) was strongly associated with lack of interest in using PrEP, and individuals who endorsed this belief were more likely to report sexual risk taking behavior. Conspiracy beliefs related to PrEP were reported among a large minority of the sample (42%) and were more frequently reported among BMTW than WMTW. Given the strong emphasis on the use of biomedical strategies for HIV prevention, addressing sociocultural barriers to PrEP access is urgently needed and failure to do so will weaken the potential benefits of biomedical prevention.
Trust and mistrust are not simply opposites of one another. These findings provide evidence for the complexity of understanding the relationship between health care trust, mistrust and patient-related health beliefs and behaviours.
Tangible support is amenable by interventions such as building and strengthening supportive networks and paraprofessional services. Socially supportive interventions should be considered critical in efforts to decrease HIV health disparities among transgender women.
Community-wide awareness that ART provides protection against HIV has the
potential to increase perceived safety and thereby increase condomless anal sex
among men who have sex with men (MSM). Furthermore, reductions in condom use can
increase exposure to sexually transmitted infections, which in turn can reduce
the protective effects of ART on HIV transmission. The current study extends
previous community-based behavioral surveillance research on beliefs regarding
use of ART for HIV prevention and sexual practices among MSM. Anonymous
cross-sectional community surveys were collected from 1831 men at the same Gay
pride event in Atlanta, GA four times over nearly two decades; 1997,
2005–2006 (the 2006 survey over-sampled African Americans to diversify
the study), and 2015. Results indicate clear and consistent trends of increasing
beliefs that HIV treatments reduce HIV transmission risks, reflecting the
dissemination of HIV prevention research findings. Changes in treatment beliefs
coincide with increased rates of condomless anal intercourse. Increased beliefs
that treatments prevent HIV and increased condomless anal sex were observed for
both HIV positive men and men who had not tested HIV positive. Results
illustrate the emergence of an era where ART is the focus of HIV prevention and
community-held beliefs and behaviors regarding definitions of risk create a new
and potentially problematic environment for HIV transmission.
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