Facilitators and Barriers to Pre-Exposure Prophylaxis (PrEP) Use Among Black Individuals in the United States: Results from the National Survey on HIV in the Black Community (NSHBC)

Abstract

This study explores willingness to use PrEP among Black individuals in the US. From February to April 2016, an online survey was administered to a nationally representative sample of Black individuals. 855 individuals who were HIV negative by self-report participated [mean age: 33.6 (SD 9.2); 45.5% male]. Among all respondents, 14.5% were aware of, and 26.0% would be willing to use PrEP. Among high-risk individuals (N = 327), 19.8% knew about and 35.1% would be willing to use PrEP. The most common reason for lack of willingness among high-risk individuals was low self-perceived risk (65.1%). In multivariate analysis, individuals reporting single marital status [OR 1.8 (1.2, 2.5), p = 0.002], depressive symptoms [OR 1.6 (1.2, 2.2), p = 0.0054], arrest history [OR 1.7(1.2, 2.4), p = 0.0003], PrEP knowledge [OR 1.5 (1.0, 2.3), p = 0.0247] and belief in HIV conspiracies [OR 1.3 (1.1, 1.5), p = 0.0075] were more willing to use PrEP. Participants who saw a health care provider less frequently were less willing to use PrEP [OR 0.5 (0.4, 0.8), p = 0.0044]. Among a nationally representative sample of Black individuals, few high risk individuals were willing to use PrEP. Interventions to increase risk awareness, PrEP knowledge and access to care are necessary to improve PrEP uptake.

Barriers to linking high-risk jail detainees to HIV pre-exposure prophylaxis

“…These participants also alluded to feelings of broader social shame given that IDU and same-sex behaviors are often associated with considerable social stigmas. Again, this mirrors prior research among non-incarcerated populations [16,18].…”

Key barriers and enablers associated with uptake and continuation of oral pre-exposure prophylaxis (PrEP) in the public sector in Zimbabwe: Qualitative perspectives of general population clients at high risk for HIV

“…However, if their risk changes (e.g., they are not sexually active or have one partner known to be HIV negative), they can discontinue PrEP after at least 28 days after their last exposure. Qualitative studies that were conducted in Kenya and the United States [34][35][36] also highlight the key roles played by HCWs in counseling clients for PrEP adherence, other prevention methods and community awareness in order to improve PrEP acceptability. Future studies should focus on the perspective of HCWs as they perform counseling and rollout of PrEP to identify ongoing challenges.…”

Limited Knowledge and Mixed Interest in Pre-Exposure Prophylaxis for HIV Prevention Among People Who Inject Drugs

“…Strategies that align HIV risk perceptions and actual behaviors may also be needed to increase PrEP interest for some high-risk individuals. 50 For example, counseling involving motivational interviewing could help individuals recognize and discuss their HIV risks, increase their motivation for HIV risk reduction, and improve their knowledge of PrEP. [51][52][53][54][55] By creating and leveraging internal motivation, rather than imposing recommendations, motivational interviewing could be positively received among PWID, a socially marginalized population with mistrust of the healthcare system.…”