Experiences of Pre-Exposure Prophylaxis (PrEP)–Related Stigma among Black MSM PrEP Users in Los Angeles

Abstract

Black men who have sex with men (BMSM) are disproportionately affected by HIV infection in the USA. Pre-exposure prophylaxis (PrEP) is a proven efficacious biomedical prevention strategy with the potential to alter significantly the course of the epidemic in this population. However, the social stigma attached to PrEP and those who use it may act as a barrier to the uptake and continuation of PrEP among high-risk BMSM. In-depth, semi-structured qualitative interviews were conducted with 26 BMSM PrEP users to explore their experiences of stigma related to their PrEP use. BMSM reported multiple experiences or manifestations of PrEP-related stigma, which included (1) perception that PrEP users engage in elevated sexual risk behaviors; (2) conflicts in relationships attributed to PrEP; (3) experiences of discomfort or judgment from medical providers; (4) assumption that PrEP users are HIV-positive; and (5) gay stigma in families limiting PrEP disclosure. The experiences of stigma typically occur within the context of PrEP disclosure and have significant personal and social consequences for PrEP users. Efforts to address PrEP and other social-stigmas within the Black community may help facilitate PrEP uptake and continuation with BMSM.

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

“…Participants reported judgement from medical providers, and discomfort with medical providers [174] Focus groups of gay, bisexual, and other MSM in Boston, Massachusetts and Jackson, Mississippi (N = 35)…”

“…Greater medical mistrust was associated with lower willingness to take PrEP [181] cis cisgender, HIV human immunodeficiency virus, MSM men who have sex with men, PrEP pre-exposure prophylaxis, PWID people who inject drugs, TGW transgender women a Please see study of Black MSM in the ' 'Sexual orientation'' category, also applicable here [188] b Please see study of Black MSM aged 16-25 years in the ' 'Sexual orientation' ' category, also applicable here [189] c Please see study of Black MSM in the ' 'Sexual orientation' ' category, also applicable here [174] Cost/insurance concerns were reported as barriers in 36% of patients [161] Interviews with MSM at Rhode Island Department of Corrections (N = 26)…”

Mind the Gap: HIV Prevention Among Young Black Men Who Have Sex with Men

“…As a result, Black MSM have expressed experiencing heightened PrEP stigma, leading to distrust that affects agency in both medical decision-making and comfort discussing sexuality and behavior with medical providers [27,46,47]. Specifically, YBMSM and transgender women who have sex with men (TGWSM) express additional stigma surrounding promiscuity assumptions, cost, and other conspiracy beliefs as deterrents from PrEP use [48][49][50][51][52]. For those who do initiate PrEP, it has been found to be effective and well tolerated among adolescent populations, but adherence with quarterly visits may wane over time, particularly among YBMSM [49,53].…”

Awakening to an Intersectional Reality: Ending the HIV Epidemic in the USA Starts with Reducing Inequities among Black MSM

“…Five of the articles in this special issue examined sociocultural assets among Black MSM-offering evidence to inform intervention strategies that buffer against intersectional stigmas and other oppressive social processes. In the White et al [12] study of Black MSM in Baltimore, membership in the house and ballroom community and having a larger number of network members living with HIV were both associated with high self-efficacy of communicating with peers regarding men's health issues. Using data from the largest domestic prospective cohort study of Black MSM (HPTN 061)-drawn from six cities (i.e., Atlanta, Boston, Los Angeles, New York, San Francisco, Washington DC)-Okafaor et al [13] found that most participants living with HIV communicated their status to their last male sex partner and that disclosure was associated with lower odds of condomless receptive anal intercourse with an HIV serodiscordant or HIV status unknown partner.…”