Shared decision making for HIV pre-exposure prophylaxis (PrEP) with black transgender women

Abstract

Shared decision making is a collaborative process intended to develop a treatment plan that considers both the patient's preferences and the health provider's medical recommendations. It is one approach to reducing healthcare disparities by improving patientprovider communication and subsequent health outcomes. This study examines shared decision making about HIV pre-exposure prophylaxis (PrEP) with Black transgender women in Chicago, Illinois, USA, given high prevalence of HIV and disparities in PrEP use. Black transgender women were recruited online and in-person to participate in semi-structured interviews (n ¼ 24) and focus groups (2; n ¼ 14 total), conducted between 2016 and 2017. Iterative thematic content analysis took place. Analysis revealed that internalised transphobia and racism, combined with stigma from service providers, prevented disclosure of gender and sexual identity to providers. Stigma about PrEP as it relates to Black transgender women results in stereotype threat, which undermines patient-provider trust and deters shared decision making for PrEP. Shared decision making promotes cultural competence and humility and builds trust within the patient-provider relationship, leading to better communication and less stigma. The involvement of peers may be one way to mitigate stigma for Black transgender women around PrEP, promote cultural competence within organisations, and empower engagement in shared decision making for HIV prevention.

Improved PrEP Awareness and Use among Trans Women in San Francisco, California

“…These barriers to PrEP are exacerbated for Black trans women and are of particular concern given that Black trans women are disproportionately affected by HIV [ 21 ]. A recent meta-analysis found that Black trans women compared to white trans women and trans women of all other races had a significantly higher HIV prevalence estimate [ 22 ] and the National HIV Surveillance System reported that the majority (51%) of all new HIV diagnoses among trans women in the United States are among Black trans women [ 23 ]. The risk of HIV infection for Black trans women and other trans women of color is highly affected by the intersection of discrimination and stigma they face due to sexism, racism, homophobia and transphobia [ 11 ] This intersectionality of discrimination and oppression results in both high HIV prevalence as well as barriers to and trust in HIV prevention methods such as PrEP [ 24 , 25 ].…”

Integrative Review of Black Birthing People’s Interactions With Clinicians During the Perinatal Period

“…41 Provider bias has also been found to negatively influence shared decision-making in adults with diabetes, 42 veterans with mental health care needs, 43 and adults who identify as lesbian, gay, bisexual, or transgender. 44-46…”

Decision conflict and the decision support needs of HIV PrEP-eligible Black patients in Toronto regarding the adoption of PrEP for HIV prevention

“…Despite the decision to adopt PrEP being complex, there are limited studies that have investigated the decisional needs of Black patients who are asked to consider adopting PrEP for HIV prevention 31 . The main objective of this study was to assess the decisional support needs of Black patients who are offered PrEP for HIV prevention.…”

“…This concept has been demonstrated in clinical trials across various populations and health domains, [24][25][26][27][28] but has only recently received attention in HIV prevention. 29,30 Despite the decision to adopt PrEP being complex, there are limited studies that have investigated the decisional needs of Black patients who are asked to consider adopting PrEP for HIV prevention 31 . The main objective of this study was to assess the decisional support needs of Black patients who are offered PrEP for HIV prevention.…”