HIV-Related Mistrust (or HIV Conspiracy Theories) and Willingness to Use PrEP Among Black Women in the United States

Abstract

Uptake of pre-exposure prophylaxis (PrEP) among Black women living in the US is suboptimal. We sought to determine the association between HIV conspiracy beliefs (HIV-related medical mistrust) and willingness to use PrEP among Black women. We analyzed data from the 2016 National Survey on HIV in the Black Community (NSHBC), a nationally representative crosssectional survey. Among NSHBC participants, 522 were women and 347(66.5%) reported expanded PrEP indications. Only 14.1% were aware that PrEP exists; 30.8% reported willingness to use PrEP. HIV-related medical mistrust was reported by 60.4% of women. In multivariable analysis, controlling for income, education, marital status and health care engagement, belief in conspiracy theories was significantly associated with higher willingness to use PrEP. The conspiracy scale item: "there is a cure for HIV, but the government is withholding it from the poor" was independently associated with PrEP willingness. This finding speaks to the need for an improved understanding of the role of HIV-related medical mistrust among Black women to improve uptake of biomedical HIV prevention. KeywordsHIV and women; women and pre-exposure prophylaxis; mistrust and PrEP; HIV conspiracy theories; HIV-related medical mistrust and PrEP; Black women and PrEP; African-American women and PrEP

Content matters. Different predictors and social consequences of general and government-related conspiracy theories on COVID-19

“…However, some research has shown that endorsing conspiracy theories can have some positive consequences, as it allows individuals to question social hierarchies and, as a result, encourage governments to be more transparent ( Clarke, 2002 ; Fenster, 1999 ; Swami & Coles, 2010 ). In a medical context, there is some evidence that belief in HIV-related conspiracy theories is significantly positively associated with HIV-testing ( Ford, Wallace, Newman, Lee, & Cunningham, 2013 ) and with the willingness to use pre-exposure prophylaxis ( Ojikutu et al, 2020 ). We argue that a better understanding of when and why conspiracy theories have different consequences requires focusing on the content of an endorsed conspiracy theory.…”

Sexual Exposure to HIV Infection during the COVID-19 Pandemic in Men Who Have Sex with Men (MSM): A Multicentric Study

“…Trying to deal with this scenario requires developing new forms of coping, as many forms of personal contact became unfeasible during the pandemic, such as group activities, parties, gym and family contact. This context increases the uncertainties about the future and safety of the population, especially for LGBTQIA2+ [ 39 , 40 ], historically more affected by lack of social support, inequalities and difficulties in accessing the health services. It is believed that these practices can represent an escape valve from the harmful social effects of the pandemic, modulated by individual behaviors, not exclusive to Brazilian or Portuguese MSM, but at the global level [ 21 ].…”

“…In an unexpected scenario, in which their usual social supports (family and friends) have limited, and sometimes precluded contact, the search for a routine health monitoring is in a second place, but does not hinder the search for sexual experiences. In a risk compensation logic [ 40 , 41 ], the already known barriers to accessing health services (fear, stigma, and welcoming) are added to the risk of being exposed to COVID-19, in contrast to the pleasure and release offered by sex in a stressful situation. It is important to point out that failure to comply with the social distancing measures does not exempt MSM from the concern about at-risk exposure to HIV infection, since the behavior is an attempt to reduce the deleterious effects of the pandemic [ 18 , 23 , 42 , 43 ].…”

PrEP for women: An update for healthcare providers

“…28 There are numerous barriers to PrEP use among Black women, including underestimation of risk by healthcare providers, lack of access to providers who prescribe PrEP, medical mistrust, and healthcare providers who have racial or other biases that negatively impact clinical decision making. 29…”