Exploring the Pre-exposure Prophylaxis (PrEP) Health Care Experiences Among Men Who Have Sex With Men (MSM) Who Live in Rural Areas of the Midwest

Owens, Christopher L.; Hubach, Randolph D.; Williams, Deana; Lester, Jessica Nina; Reece, Michael; Dodge, Brian

doi:10.1521/aeap.2020.32.1.51

Cited by 33 publications

(29 citation statements)

References 56 publications

(65 reference statements)

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“…A 2020 qualitative study of barriers and facilitators to PrEP for rural MSM in the Midwest also found a need for increased awareness of PrEP, particularly via publicfacing media such as radio and television. 31 Fourth, although stigma may manifest in many ways, this predominantly rural and small urban sample reported low levels of concern about some aspects of stigma concerning PrEP, including discussing PrEP with health care providers and friends, family, or partners discovering PrEP use. Both PrEP initiators and non-initiators expressed low levels of concern in these areas, which may have been affected by survey nonresponse.…”

Section: Discussionmentioning

confidence: 81%

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Predictors of HIV Preexposure Prophylaxis Initiation Among Public Health Clients in Rural and Small Urban Areas in Iowa

et al. 2020

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Objective Preexposure prophylaxis (PrEP) is a safe and effective method for HIV prevention, but little is known about PrEP uptake in rural and small urban areas. We described rates and predictors of HIV PrEP initiation among public health clients in rural and small urban areas in Iowa. Methods This was a prospective cohort study of clients with PrEP indications served by HIV testing and disease intervention specialist/partner services (DIS/PS) programs in public health departments in Iowa from February 1, 2018, through February 28, 2019. Eligible participants were aged 18-70 and referred for PrEP by public health personnel. Participants completed surveys at enrollment addressing demographic characteristics; sexual history; previous drug use; PrEP experiences; and knowledge, attitudes, and beliefs about PrEP. A follow-up survey assessed PrEP initiation at 30 days. We compared baseline characteristics of PrEP initiators and non-initiators. Results Two hundred thirty-four public health clients consented to participate in the study; 189 completed the baseline survey, and 117 (61.9%) completed the follow-up survey. The mean age of participants in the baseline survey was 30 (range, 18-68); 109 (57.7%) were male, 127 (67.2%) were White, and 169 (89.4%) lived in a rural or small urban area. Of 117 participants in the follow-up survey, those who initiated PrEP were significantly more likely than those who did not initiate PrEP to be referred by DIS/PS programs (46.7% vs 7.8%, P < .001) and to recognize that PrEP was ≥90% effective (86.7% vs 35.3%, P = .001). No PrEP initiators and 8 PrEP non-initiators agreed that PrEP is for promiscuous people (0% vs 7.8%, P = .04). Perceived PrEP stigma was low and not associated with PrEP initiation. Conclusions PrEP initiation rates were low among rural and small urban health department clients. Interventions are needed to improve linkage to PrEP among rural and small urban public health clients.

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Section: Discussionmentioning

confidence: 81%

“…A 2020 qualitative study of barriers and facilitators to PrEP for rural MSM in the Midwest also found a need for increased awareness of PrEP, particularly via public-facing media such as radio and television. 31…”

Section: Discussionmentioning

confidence: 99%

Predictors of HIV Preexposure Prophylaxis Initiation Among Public Health Clients in Rural and Small Urban Areas in Iowa

et al. 2020

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“…Negative attitudes of HCW toward PrEP could adversely affect their communication with potential PrEP users 37 or even their own decisions to prescribe PrEP. 38 Depriving eligible MSM from PrEP access because of the anticipated risks of fueling STI infections may not be in the best public health interest. 39 Studies in different nations, such as the US, 35,40 Canada, 35 Kenya, 41 and Belgium 42 demonstrated the importance of capacity development for HCW to enhance PrEP delivery to achieve successful scale up.…”

Section: Discussionmentioning

confidence: 99%

“…43 One most prominent theme of our findings was the affordability of PrEP, which was in line with that of the other studies reported in countries and regions in Europe, 44 Asia, 44,45 and North America. 38,46 Guidelines on PrEP promulgated by WHO have highlighted that equitable access will contribute to reducing health disparity gap. 47 In Hong Kong, the current price of the medication per month is around HK$6000 (∼US$770), 48 and up to $8000-$10,000 (∼US$1025-1280) if check-ups and monitoring are included as in the private sector, 49 which are generally unaffordable.…”

Section: Discussionmentioning

confidence: 99%

What makes an optimal delivery for PrEP against HIV: A qualitative study in MSM

et al. 2022

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Background Pre-exposure prophylaxis (PrEP) is an effective means of HIV prevention for men who have sex with men (MSM), a key population whose engagement is crucial for achieving effective public health outcomes. An optimal service model would be important in planning the implementation of PrEP in places where such service has not been established. Methods A qualitative study was conducted to delineate the attributes of an optimal PrEP service model for MSM in Hong Kong, a city where no formal PrEP programs existed. Twenty purposively sampled MSM who were enrollees of two pilot PrEP projects participated in the semi-structured interviews promoting story-telling. The coded data were thematically analyzed following Grounded Theory approach, focusing on uncovering a typology of the essential attributes of an optimal PrEP service model, and the reasons for such preferences. Results Participating MSM were all ethnic Chinese and aged 26 to 52 years. All had received PrEP from pilot projects in conjunction with periodic screening of sexually transmitted infections (STI), HIV antibody, and plasma creatinine. Four major themes emerged as regards the attributes of a preferred PrEP service: (i) comprehensiveness of HIV/STI and safety monitoring; (ii) convenient unitary service; (iii) stigma-free PrEP access and protecting confidentiality; and (iv) affordable price. Whereas regular provision of PrEP was acceptable to MSM, unaffordability and related stigma were the anticipated challenges for potential service providers. Conclusions The qualitative assessment of MSM’s preference for PrEP service delivery has yielded important information on the many facets of a desirable service model.

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“…The transcripts and recordings were reviewed with attention to both the narrative thread and the themes for each narrator. Identi cation of themes is a commonly used method in health research (26,27). Researchers such as the aforementioned typically seek to locate distinct themes across a number of participants.…”

Section: Methodsmentioning

confidence: 99%

Decision-Making for HIV AIDS Prevention: Altruism and the Moral Norm

Campbell¹,

Johnson²

2021

Preprint

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Background; the purpose of this enquiry was to understand how gay men form and maintain their attitudes towards HIV transmission preventative behaviors. The cost of HIV/AIDS to society is very high and increasing. The pressing need is to increase the rate of behavioral adherence to methods intended to prevent the transmission of the HIV virus to gay men, the most at-risk population. Current knowledge about how to increase/maintain adherence comes from research primarily focused on understanding current behavior. The purpose of this enquiry was to understand more about how gay men initially form and then maintain their attitudes towards preventative behaviors.Methods; Using the Narrative Inquiry method, we recruited sixteen gay men from the Melbourne gay milieu, who narrated their autobiographical life histories. (The term narrated is consistent with the Narrative Inquiry method.). Each narrator’s autobiographical life history was reviewed as one whole, and themes within each were identified. One of the researchers is a gay man who had been immersed in the narrators’ milieu since 1985, closely involved with HIV/AIDS as an experiential phenomenon. He was therefore able to understand each life story as personal experience and embrace it intellectually.Results; Once the narrators acquired knowledge of preventative behavior they consistently adhered to that behavior. They adhered because of fear of HIV infection and because they held a moral norm that obligated them to behave altruistically to achieve values important to them; to protect not only themselves, but also their sex partners, loved ones, and their positive self-evaluation. They saw their HIV negative status, and their adherence, as both pre-requisites and enablers for achieving their goals in life. They took a long-term view of life and planned accordingly. Their autobiographies were a narrative of their life trajectory their Quest for the Ideal Gay Life, in whatever terms they imagined it. Conclusions; Dick and Basu’s Framework for Customer Loyalty, a commercial marketing communications theoretical framework, explains development and maintenance of these men’s loyalty (their consistent adherence). This understanding, within a marketing communications framework, will inform development of social marketing communications aiming to increase adherence to behaviors that prevent HIV transmission.

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Exploring the Pre-exposure Prophylaxis (PrEP) Health Care Experiences Among Men Who Have Sex With Men (MSM) Who Live in Rural Areas of the Midwest

Cited by 33 publications

References 56 publications

Predictors of HIV Preexposure Prophylaxis Initiation Among Public Health Clients in Rural and Small Urban Areas in Iowa

Predictors of HIV Preexposure Prophylaxis Initiation Among Public Health Clients in Rural and Small Urban Areas in Iowa

What makes an optimal delivery for PrEP against HIV: A qualitative study in MSM

Decision-Making for HIV AIDS Prevention: Altruism and the Moral Norm

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