HIV Pre-Exposure Prophylaxis Stigma as a Multidimensional Barrier to Uptake Among Women Who Attend Planned Parenthood

Calabrese, Sarah K.; Dovidio, John F.; Tekeste, Mehrit; Taggart, Tamara; Galvao, Rachel W.; Safon, Cara B.; Willie, Tiara C.; Caldwell, Abigail; Kaplan, Clair; Kershaw, Trace

doi:10.1097/qai.0000000000001762

Cited by 119 publications

(87 citation statements)

References 26 publications

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“…To develop the HPSS, we reviewed literature regarding PrEP stigma and identified key sources for items: a study of stigma as a multidimensional barrier, [34] studies of barriers and facilitators to PrEP acceptability, [35,36] measures from the Adolescent Medicine HIV Trials Network for HIV/AIDS Interventions (ATN) U19 Scale It Up, [37,38] and measures from an HIV Prevention Trials Network Study, HPTN082 [39,40]. We sought to include studies representing a broad range of characteristics; in total, there were 1586 participants in these studies, including 402 men, 1171 women, and 7 transgender men; 824 heterosexual, 140 bisexual, and 154 gay/homosexual persons; 666 Black, 250 White, 184 Latino, and 13 Asian; and 400 participants from international settings.…”

Section: Scale Developmentmentioning

confidence: 99%

Validation of the HIV Pre-exposure Prophylaxis Stigma Scale: Performance of Likert and Semantic Differential Scale Versions

et al. 2020

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Stigma regarding HIV pre-exposure prophylaxis (PrEP) is commonly implicated as a factor limiting the scale-up of this highly effective HIV prevention modality. To quantify and characterize PrEP stigma, we developed and validated a brief HIV PrEP Stigma Scale (HPSS) among a group of 279 men who have sex with men (MSM). Scale development was informed by a theoretical model to enhance content validity. We assessed two scale versions, Semantic Differential and Likert, randomizing the order in which scales were presented to participants. Both scales demonstrated high internal consistency. The Likert scale had substantially better construct validity and was selected as the preferred option. Scale scores demonstrated construct validity through association with constructs of interest: healthcare distrust, HIV knowledge, perceived proportion of friends/partners on PrEP, perceived community evaluation of PrEP, and perceived effectiveness of PrEP. The scale accounted for 25% of the total variance in reported willingness to be on PrEP, indicating the substantial role PrEP stigma may have on decisions to initiate PrEP. Given increased efforts to roll-out PrEP, having a valid tool to determine the level and types of PrEP stigma in individuals, groups, and communities can help direct implementation plans, identify goals for stigma reduction, and monitor progress over time.

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Section: Scale Developmentmentioning

confidence: 99%

Validation of the HIV Pre-exposure Prophylaxis Stigma Scale: Performance of Likert and Semantic Differential Scale Versions

et al. 2020

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“…Stigma can be particularly high in contexts where community awareness about PrEP is low, cultural norms dictate that unmarried women should not be sexually active or should practice monogamy, and PrEP was initially prioritized for "high-risk" key populations, including female sex workers (FSWs) [14,[19][20][21]. Quantitative analyses among men who have sex with men (MSM) in the United States and Africa and heterosexual women in the United States have found that stigma significantly reduces PrEP interest, uptake and adherence [14,[22][23][24][25][26][27][28]. Stigma may also influence African women's PrEP adherence as shown by qualitative work conducted among AGYW and FSWs that describes women's need to discreetly use HIV prevention products and miss doses because of concerns around stigma [18,19,[27][28][29][30].…”

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confidence: 99%

The influence of HIV‐related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082: a qualitative study

et al. 2020

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Introduction Stigma and disclosure concerns have been key barriers to oral pre‐exposure prophylaxis (PrEP) adherence for African adolescent girls and young women (AGYW) in efficacy trials. We aimed to understand the impact of these factors among African AGYW in an open‐label PrEP study. Methods HPTN 082 was an open‐label PrEP study among AGYW (ages 16 to 24) in Harare, Zimbabwe, and Cape Town and Johannesburg, South Africa from 2016 to 2018. Women starting PrEP were randomized to standard adherence support (counselling, two‐way SMS, monthly adherence clubs) or standard support plus drug‐level feedback. Serial in‐depth interviews were conducted among 67 AGYW after 13‐week and 26‐week study visits to explore experiences of stigma, disclosure and PrEP adherence. We analysed data by coding transcripts and memo‐writing and diagramming to summarize themes. Results AGYW described stigma related to sexual activity (e.g. “people say I'm a prostitute”) and being perceived to be living with HIV because of taking antiretrovirals (e.g. “my husband's friends say I'm HIV infected”). Participants who anticipated stigma were reluctant to disclose PrEP use and reported adherence challenges. Disclosure also resulted in stigmatizing experiences. Across all sites, negative descriptions of stigma and disclosure challenges were more common in the first interview. In the second interview, participants often described disclosure as an “empowering” way to combat community‐level PrEP stigma; many said that they proactively discussed PrEP in their communities (e.g. became a “community PrEP ambassador”), which improved their ability to take PrEP and encourage others to use PrEP. These empowering disclosure experiences were facilitated by ongoing HPTN 082 study activities (e.g. counselling sessions, adherence clubs) in which they could discuss PrEP‐related stigma, disclosure and PrEP adherence issues. Conclusions Stigma and disclosure challenges were initial concerns for African AGYW newly initiating PrEP but many were empowered to disclose PrEP use over their first six months of PrEP use, which helped them cope with stigma and feel more able to take PrEP regularly. PrEP programmes can foster disclosure through community and clinic‐based discussion, adherence clubs and activities normalizing sexual behaviour and PrEP use, which can reduce stigma and improve PrEP adherence and thus effectiveness.

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“…Our results show that prior to the training, participants had a high awareness of PrEP, high perceived knowledge, but low actual knowledge of PrEP. We observed a statistically significant increase in PrEP stigma has been identified as a major barrier to PrEP uptake and adherence globally [39,52,53].…”

Section: Discussionmentioning

confidence: 74%

Acceptability, Appropriateness, and Preliminary Effects of the PrEP Diffusion Training for Lay HIV Workers: Increased PrEP Knowledge, Decreased Stigma, and Diffusion of Innovation

Ye²,

Meyers³

2020

Preprint

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Background Training lay health workers is a critical strategy for HIV pre-exposure prophylaxis (PrEP) implementation, but little is known about effective approaches to conducting and evaluating such trainings. We evaluated the effect of the PrEP Diffusion Training, a one-day participatory training informed by the Diffusion of Innovation theory, on knowledge, PrEP stigma, implementation behavior, and diffusion of PrEP innovation among lay HIV workers in China.Methods Nine PrEP Diffusion Trainings were delivered to 220 lay HIV workers. We conducted multi-time-point surveys to assess acceptability, appropriateness, and preliminary effects of the training on participants’ knowledge, PrEP stigma, determinants of implementation behavior, and diffusion of PrEP information. We used an observation-based checklist to evaluate implementation fidelity.Results All trainings were delivered with high fidelity to the standardized manual, with little variability across sites. Acceptability and appropriateness of training were high. PrEP knowledge score significantly increased by 65% from pre-training to post-training, and remained high one month after the training. We observed a significant decrease in PrEP stigma and a positive influence on determinants of implementation behaviors. All participants surveyed one-month after the training reported having shared PrEP information in their social networks, and 43% reported integrating PrEP education into their routine HIV prevention work on a regular basis.Conclusions The PrEP Diffusion Training is a practical and effective strategy to build lay HIV workers’ capacity to participate in PrEP implementation. Longer-term follow up post training would be ideal to further assess actual PrEP uptake and sustained effects of intervention on PrEP implementation.

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HIV Pre-Exposure Prophylaxis Stigma as a Multidimensional Barrier to Uptake Among Women Who Attend Planned Parenthood

Abstract: Findings highlight the need for positive messaging targeting potential PrEP users and their social networks to increase PrEP acceptance and uptake.

Cited by 119 publications

References 26 publications

Validation of the HIV Pre-exposure Prophylaxis Stigma Scale: Performance of Likert and Semantic Differential Scale Versions

Validation of the HIV Pre-exposure Prophylaxis Stigma Scale: Performance of Likert and Semantic Differential Scale Versions

The influence of HIV‐related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082: a qualitative study

Acceptability, Appropriateness, and Preliminary Effects of the PrEP Diffusion Training for Lay HIV Workers: Increased PrEP Knowledge, Decreased Stigma, and Diffusion of Innovation

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