Latent profiles of stigma and HIV pre-exposure prophylaxis among Black sexual minority men: an exploratory study

Abstract

Black sexual minority men (BSMM) are a priority population for HIV prevention efforts, including pre-exposure prophylaxis (PrEP) promotion. Intersectional stigma can be associated with deterrence from PrEP utilization among BSMM; this stigma has a novel context in the COVID-19 pandemic. To examine this, we investigated latent profiles of racial, sexuality-based, and related stigmas among HIV-negative BSMM in the COVID-19 pandemic and tested their association with PrEP use. We analyzed cross-sectional data from a pilot sample of HIV-negative BSMM ( n = 151) collected between July 2nd and September 3rd, 2020 in the United States, primarily located on the east coast. We conducted latent profile analysis using internalized racism and homophobia, anticipated racism and homophobia, HIV stigma, healthcare stigma, and PrEP stigma. We then tested associations between latent profiles and both PrEP use (binary) and PrEP acceptability (ordinal) using modified Poisson regression and cumulative log models, respectively. We identified three latent profiles, characterized as ‘Low Internalized Stigma, High Anticipated Stigma’ (reference profile), ‘High Internalized Stigma, Low Anticipated Stigma,’ and ‘High Internalized and Anticipated Stigma.’ The ‘High Internalized and Anticipated Stigma’ profile was associated with PrEP use (aPR 0.37, 95% CI 0.17, 0.82) and acceptability (aPR 0.32, 95% CI 0.18, 0.57) nearly three times as low as the comparing profile after adjustment for confounders. The ‘High Internalized Stigma, Low Anticipated Stigma’ was also associated with PrEP acceptability nearly three times as low as the reference (aPR 0.38, 95% CI 0.22, 0.68). We identified latent profiles characterized by internalized and anticipated stigmas among BSMM during the COVID-19 pandemic and found that the profile with the highest levels of both internalized and anticipated stigma was associated with the lowest PrEP use and acceptability. Internalized stigma may be a particularly relevant intervention target in efforts to promote PrEP uptake among BSMM. Supplementary Information The online version contains supplementary material available at 10.1007/s43545-022-00490-w.

Prevalence and Correlates of Sars-Cov-2 Vaccine Uptake and Hesitancy Among People With Hiv Across the U.S.

“…11 Greater vaccine hesitancy among Black vs. White PWH and at-risk of HIV has been noted in other cohorts, despite this not being noted for Black vs. White people in the general population. 9,[12][13][14][15] The finding of higher vaccine hesitancy among Black PWH may reflect the disproportionate impact of intersectional stigma and discrimination (including race, gender, and HIV status) on health outcomes among Black PWH, in particular among Black women with HIV in our analysis, compounding experiences of distrust of public health authorities. 9,[12][13][14][15] Given that 72% of those with vaccine hesitancy wanted more to be known about the SARS-CoV-2 vaccine before receiving it, with Black vs. White PWH having greater mistrust of vaccine approval, it is possible that accelerated vaccine approval may have reinforced mistrust of public health authorities among racialized populations (i.e., because of knowledge of the Tuskegee Syphilis Experiment, discriminatory recruitment for studies, and disparities in medical services offered for conditions such as acute pain).…”

“…9,[12][13][14][15] The finding of higher vaccine hesitancy among Black PWH may reflect the disproportionate impact of intersectional stigma and discrimination (including race, gender, and HIV status) on health outcomes among Black PWH, in particular among Black women with HIV in our analysis, compounding experiences of distrust of public health authorities. 9,[12][13][14][15] Given that 72% of those with vaccine hesitancy wanted more to be known about the SARS-CoV-2 vaccine before receiving it, with Black vs. White PWH having greater mistrust of vaccine approval, it is possible that accelerated vaccine approval may have reinforced mistrust of public health authorities among racialized populations (i.e., because of knowledge of the Tuskegee Syphilis Experiment, discriminatory recruitment for studies, and disparities in medical services offered for conditions such as acute pain). 16 Although concern regarding vaccine contents and mistrust of public health authorities were important factors driving vaccine hesitancy among Black PWH, care engagement was not associated with lower vaccine hesitancy among The proportion of people living with HIV in the study cohort who reported not having yet received the vaccine is graphed in blue over 7 two-month periods.…”