Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts

Abstract

Gay and bisexual men and other men who have sex with men (MSM) account for more than two thirds of new HIV infections in the U.S., with Black MSM experiencing the greatest burden. Antiretroviral pre-exposure prophylaxis (PrEP) can reduce MSM's vulnerability to HIV infection. Uptake of PrEP has been limited, particularly among racial and ethnic minority MSM. Four semi-structured focus groups with gay and bisexual men and other MSM at risk for HIV infection were convened in Boston and Jackson in late 2013. The analysis plan utilized a within-case, across-case approach to code and analyze emerging themes, and to compare results across the two cities. Participants recruited in Jackson were primarily Black gay men, while Boston participants were mostly non-Hispanic White gay men. Participants in both sites shared concerns about medication side effects and culturally insensitive health care for gay men. Jackson participants described stronger medical mistrust, and more frequently described experiences of anti-gay and HIV related stigma. Multiple addressable barriers to PrEP uptake were described. Information about side effects should be explicitly addressed in PrEP education campaigns. Providers and health departments should address medical mistrust, especially among Black gay and bisexual men and other MSM, in part by training providers in how to provide affirming, culturally competent care. Medicaid should be expanded in Mississippi to cover low-income young Black gay and bisexual men and other MSM.

Pre-exposure prophylaxis for MSM and transgender persons in early adopting countries

“…Some subpopulations are at particularly high risk for HIV because of the concentration of undiagnosed and untreated HIV within their sexual networks. For example, in the U.S., black MSM represent a group at very high risk of acquiring HIV infection [33-35], however, PrEP uptake has been disproportionately low compared to non-black MSM [36-38] which may be attributable to assortative mixing (preferentially choosing partners from within one's ethnic group, thereby concentrating risk per contact) and limited social mobility, disparities in health care access, and distrust of culturally-insensitive health care systems [39, 40]. Some data suggest that 85% of the infections among migrant MSM in Europe occur post-migration [41], but there is limited evidence [42] about PrEP uptake among specific racial and ethnic MSM subgroups in Europe and Australia.…”

Pre‐exposure prophylaxis initiation and adherence among Black men who have sex with men (MSM) in three US cities: results from the HPTN 073 study

“…Limited research is available on the initiation of and adherence to PrEP among Black MSM in the US . The importance of developing effective interventions and methods for delivering these interventions is essential to reducing the disproportionate HIV burden among BMSM in the United States inclusive of health provider biases .…”

“…Evidence‐based research is needed to address this vital public health priority, including culturally sensitive care and support services that address the structural barriers . We report results from an open‐label antiretroviral PrEP demonstration project, HIV Prevention Trials Network 073 (HPTN 073) that examined the uptake/initiation and adherence with daily oral co‐formulated emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) among Black MSM in three US cities.…”

Measuring and understanding the attitudes of Australian gay and bisexual men towards biomedical HIV prevention using cross-sectional data and factor analyses

“…Compared with established forms of primary prevention, such as condoms, biomedical prevention may be less well understood by affected communities, presenting new challenges for communicating evidence of effectiveness, increasing public health knowledge and influencing preventive behaviour. In addition, levels of understanding and acceptability of biomedical prevention within the affected and broader community are likely to affect demand and implementation success; mistrust and stigma of PrEP and TasP4 have the potential to undermine the uptake and therefore the individual-level and population-level effectiveness of biomedical HIV prevention 5…”