O02.4 It’s just not for me: exploring low prep uptake among young black men who have sex with men in the southern united states

Abstract

IntroductionPre-exposure prophylaxis (PrEP) is highly effective in preventing HIV acquisition. In the Southern United States, where young Black men who have sex with men (YBMSM) have the highest rates of new HIV infection, PrEP uptake remains low. As part of a longitudinal cohort study, YBMSM were offered optional, non-incentivized PrEP as a standard of HIV prevention care service. Among those who declined PrEP, we sought to understand their motivations, as well as their overall perceptions of PrEP as a prevention tool.MethodsThe EleMENt study is an observational HIV/STI incidence cohort of HIV-negative YBMSM aged 18–29 years in Atlanta, Georgia. We conducted 24 in-depth, semi-structured interviews with men who declined optional PrEP offered by the study. Topics included PrEP knowledge, attitudes, and intentions. We employed a phenomenological lens to identify common themes in participant accounts of the decision to forgo PrEP.ResultsParticipants fell into two categories of PrEP refusal: those who indicated no current or future interest (“nevers”) and those ambivalent about taking PrEP, but who had thus far not filled a prescription (“maybes”). YBMSM in both groups expressed mistrust of biomedical interventions, and despite being indicated for PrEP, often perceived themselves as low risk for HIV acquisition. They employed “othering” strategies, in which PrEP was described as appropriate for individuals in serodiscordant partnerships or with many casual partners. They viewed taking a daily pill as a burdensome measure only appropriate for extremely high-risk men (i.e., “the risky Other”). These perceptions were accentuated by instances of family members actively discouraged participants from taking PrEP.ConclusionWe discuss the role of future research exploring low risk estimation among YBMSM as a potential site of resistance to a public health designation of “high risk” amidst historical legacies of medical mistrust in Black communities. Such concerns must be addressed to design effective HIV and PrEP-specific interventions for this population.

Regional Disparities in Qualified Health Plans’ Prior Authorization Requirements for HIV Pre-exposure Prophylaxis in the United States

“…[6][7][8] The most frequently cited barriers in the South for low PrEP use include lack of clinicians with PrEP knowledge, absence of health insurance, stigma, and underestimation of personal HIV risk. [9][10][11][12][13] Improved HIV biomedical prevention through access to PrEP is 1 of the essential components of the federal government's Ending the HIV Epidemic initiative. 3 Although high costs [14][15][16] and lack of health insurance 17 are barriers to PrEP use, we also considered whether there may be regional differences in qualified health plans' (QHPs') benefit design associated with disparities in access to PrEP.…”

Predictors of PrEP Uptake Among Patients with Equivalent Access

“…Analyses by race/ethnicity indicate significant disparities in PrEP uptake (7), with studies citing lack of PrEP awareness and access in communities of color (8). Findings from qualitative studies stress the importance of increasing the number of comfortable and competent PrEP providers (8), and training providers to overcome the historical (and persistent) racism and discrimination experienced by patients of color in medical settings (9). Equally important are findings regarding financial barriers to PrEP; recent data indicate that concerns about cost or insurance status are the largest barriers to starting medication among individuals prescribed PrEP at a community-based clinic (10).…”

Disclosure of HIV Serostatus and Pre-exposure Prophylaxis Use on Internet Hookup Sites Among Men Who have Sex with Men

“…Interest in PrEP has been high among MSM (4), and uptake is increasing (5). Current challenges to successful PrEP implementation include suboptimal awareness, lack of access to health care, lack of insurance coverage, out-ofpocket costs, stigma, adherence, and retention in care (3,(6)(7)(8)(9)(10). These barriers may be more pronounced among Black/African American and Hispanic/Latinx MSM.…”