Brief Report: The Right People, Right Places, and Right Practices: Disparities in PrEP Access Among African American Men, Women, and MSM in the Deep South

Elopre, Latesha; Kudroff, Kachina; Westfall, Andrew O.; Overton, Edgar Turner; Mugavero, Michael J.

doi:10.1097/qai.0000000000001165

Cited by 93 publications

(61 citation statements)

References 24 publications

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“…This means that only about 3% of the targeted population is using this prevention method ( Bush et al, 2016 ). PrEP uptake is low and can be explained by a number of factors, including a lack of awareness of PrEP ( Eaton, Driffin, Bauermeister, Smith, & Conway-Washington, 2015 ; Krakower et al, 2012 ), a low perceived risk of HIV acquisition ( Pérez-Figueroa, Kapadia, Barton, Eddy, & Halkitis, 2015 ), concerns regarding potential adverse effects ( Golub et al, 2013 ), a dislike of taking medication ( Rolle et al, 2017 ), the cost of medication ( Cohen et al, 2015 ), the cost and inconvenience of required monitoring visits ( Elopre, Kudroff, Westfall, Overton, & Mugavero, 2017 ), and the requirement to undergo repeat HIV testing prior to each new prescription ( Mayer et al, 2015 ). In addition to concerns regarding low uptake of PrEP, public health specialists and researchers are concerned with PrEP adherence among users.…”

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confidence: 99%

Stigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention: A Qualitative Study

et al. 2018

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Pre-exposure prophylaxis (PrEP) uptake has been extremely low among key groups. PrEP-related stigma and shaming are potential barriers to uptake and retention in PrEP programs. There is a lack of literature describing PrEP stigma. In order to fill this gap, we recruited online 43 HIV-negative Men who have Sex with Men (MSM) who use PrEP. Semistructured interviews were conducted to explore their perceptions and experience of stigma related to PrEP use. Data were analyzed using Strauss and Corbin’s grounded theory and constant comparison techniques to enhance understanding of the lived experiences of MSM who use PrEP. The participants experienced PrEP stigma as rejection by potential/actual partners, stereotypes of promiscuity or chemsex, and labeling of both the user and the medication. They connected PrEP stigma with HIV stigma, generational differences, moralization of condom use, and inability to embrace one’s own sexuality. These findings point to a need to develop tailored interventions to address PrEP-related stigma and shaming for individuals, health-care professionals, and the MSM community-at-large.

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confidence: 99%

Stigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention: A Qualitative Study

et al. 2018

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“…Additionally, concerns about contraceptive implants’ side effect profiles and potential high cost deterred use; these same barriers also affected oral PrEP use [ 35 ]. Finally, access to contraceptive implants or oral PrEP was a challenge to use for each of these products [ 36 ]. All these concerns are likely to translate to PrEP implants.…”

Section: Discussionmentioning

confidence: 99%

Understanding the Acceptability of Subdermal Implants as a Possible New HIV Prevention Method: Multi-Stage Mixed Methods Study

et al. 2020

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Background A long-acting implant for HIV pre-exposure prophylaxis (PrEP) is in development in the Sustained Long-Action Prevention Against HIV (SLAP-HIV) trial. This could provide an alternative to oral PrEP. Objective Our mixed methods study aimed to understand (1) users’ experiences with a similar subdermal implant for contraception and (2) factors influencing the likelihood that gay and bisexual men (GBM) would use a proposed PrEP implant. Methods Work was completed in 4 stages. In stage 1, we conducted a scientific literature review on existing subdermal implants, focusing on users’ experiences with implant devices. In stage 2, we reviewed videos on YouTube, focusing on the experiences of current or former contraceptive implant users (as these implants are similar to those in development in SLAP-HIV). In stage 3, individuals who indicated use of a subdermal implant for contraception in the last 5 years were recruited via a web-based questionnaire. Eligible participants (n=12 individuals who liked implants a lot and n=12 individuals who disliked implants a lot) completed in-depth phone interviews (IDIs) about their experiences. In stage 4, results from IDIs were used to develop a web-based survey for HIV-negative GBM to rate their likelihood of using a PrEP implant on a scale (1=very unlikely and 5=very likely) based on likely device characteristics and implant concerns identified in the IDIs. Results In the scientific literature review (stage 1), concerns about contraceptive implants that could apply to the PrEP implants in development included potential side effects (eg, headache), anticipated high cost of the device, misconceptions about PrEP implants (eg, specific contraindications), and difficulty accessing PrEP implants. In the stage 2 YouTube review, individuals who had used contraceptive implants reported mild side effects related to their device. In stage 3, implant users reported that devices were comfortable, unintrusive, and presented only minor discomfort (eg, bruising) before or after insertion and removal. They mainly reported removing or disliking the device due to contraceptive-related side effects (eg, prolonged menstruation). Participants in the stage 4 quantitative survey (N=304) were mainly gay (204/238, 85.7%), white (125/238, 52.5%), cisgender men (231/238, 97.1%), and 42.0% (73/174) of them were on oral PrEP. Not having to take a daily pill increased the likelihood of using PrEP implants (mean 4.13). Requiring >1 device to achieve 1 year of protection (mean range 1.79-2.94) mildly discouraged PrEP implant use. Participants did not mind moderate bruising, a small scar, tenderness, or bleeding after insertion or removal, and an implant with a size slightly larger than a matchstick (mean ratings 3.18-3.69). Conclusions PrEP implants are promising among GBM. Implant features and insertion or removal-related concerns do not seem to discourage potential users. To ensure acceptability, PrEP implants should require the fewest possible implants for the greatest protection duration.

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“…Further, although data suggests that PrEP adoption was initially slow, trends show that PrEP prescriptions increased 73% percent each year since 2012 (AIDSvu, 2018). However, despite improvements in adoption, PrEP uptake remains incommensurate with eligibility and need (AIDSvu, 2018; Mera Giler et al, 2017; Parsons et al, 2017; Patrick et al, 2017), particularly for Black and Latino GBM, as well as in the Southern region of the United States (AIDSvu, 2018; Elopre, Kudroff, Westfall, Overton, & Mugavero, 2017; Snowden, Chen, McFarland, & Raymond, 2017). Beyond these gaps in PrEP adoption, some have expressed concerns that individuals already taking PrEP may not maintain sufficient adherence to benefit from its protection (Golub, Gamarel, Rendina, Surace, & Lelutiu-Weinberger, 2013; Taylor et al, 2017; Van der Elst et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

How Do Gay and Bisexual Men Make Up for Missed PrEP Doses, and What Impact Does Missing a Dose Have on Their Subsequent Sexual Behavior?

Grov

D’Angelo

Flynn

et al. 2018

AIDS Education and Prevention

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HIV pre-exposure prophylaxis (PrEP) is being adopted by members of key populations, such as gay and bisexual men (GBM). Since adherence to a daily PrEP regimen ensures a maximum protection, it is critical to understand GBM's behavioral responses to having missed PrEP doses. We report on qualitative interviews with GBM taking PrEP. We identified three behavioral responses: (1) 59% continued with their next scheduled dose; (2) 49% described "making up" for a missed dose by taking medication as soon as possible; and (3) 11% reported "doubling" the next PrEP dose. Participants provided potentially contradictory narratives about their sexual behavior after a missed dose: (1) 54% described making no changes; (2) 49% described adjusting their sexual behavior to reduce HIV risk; and (3) 10% said their decision would be contingent upon how many doses were missed. For PrEP prescribers, our data provide a useful lens to understand patients' lived experiences with PrEP.

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Brief Report: The Right People, Right Places, and Right Practices: Disparities in PrEP Access Among African American Men, Women, and MSM in the Deep South

Cited by 93 publications

References 24 publications

Stigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention: A Qualitative Study

Stigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention: A Qualitative Study

Understanding the Acceptability of Subdermal Implants as a Possible New HIV Prevention Method: Multi-Stage Mixed Methods Study

How Do Gay and Bisexual Men Make Up for Missed PrEP Doses, and What Impact Does Missing a Dose Have on Their Subsequent Sexual Behavior?

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