Dismantling Barriers and Transforming the Future of Pre-Exposure Prophylaxis Uptake in Young Black and Latinx Sexual Minority Men and Transgender Women

Shorrock, Fiona; Alvarenga, Aubrey; Hailey-Fair, Kimberly; Vickroy, Wil; Cos, Travis; Kwait, Jennafer; Trexler, Connie; Wirtz, Andrea L.; Galai, Noya; Beyrer, Chris; Celentano, David D.; Arrington‐Sanders, Renata

doi:10.1089/apc.2021.0222

Cited by 12 publications

(3 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Out-of-pocket cost was the most important attribute driving respondents' PrEP programme preferences across all attributes examined. Our findings are consistent with studies conducted with other priority populations, which found cost-sharing for PrEP-related care to be a key structural barrier to PrEP initiation and persistence [23,43,55,57,[65][66][67][68][69][70][71]. In accordance with the U.S.…”

Section: Discussionsupporting

confidence: 91%

HIV pre‐exposure prophylaxis programme preferences among sexually active HIV‐negative transgender and gender diverse adults in the United States: a conjoint analysis

Watson,

Listerud,

Drab

et al. 2024

J Int AIDS Soc.

View full text Add to dashboard Cite

IntroductionCurrent implementation efforts have failed to achieve equitable HIV pre‐exposure prophylaxis (PrEP) provision for transgender and gender‐diverse (trans) populations. We conducted a choice‐based conjoint analysis to measure preferences for key attributes of hypothetical PrEP delivery programmes among a diverse online sample predominantly comprised of transmasculine and nonbinary individuals in the United States.MethodsBetween April 2022 and June 2022, a national online survey with an embedded conjoint analysis experiment was conducted among 304 trans individuals aged ≥18 years in the United States to assess five PrEP programme attributes: out‐of‐pocket cost; dispensing venue; frequency of visits for PrEP‐related care; travel time to PrEP provider; and ability to bundle PrEP‐related care with gender‐affirming hormone therapy services. Participants responded to five questions, each of which presented two PrEP programme scenarios and one opt‐out option per question and selected their preferred programme in each question. We used hierarchical Bayes estimation and multinomial logistic regression to measure part‐worth utility scores for the total sample and by respondents’ PrEP status.ResultsThe median age was 24 years (range 18–56); 75% were assigned female sex at birth; 54% identified as transmasculine; 32% as nonbinary; 14% as transfeminine. Out‐of‐pocket cost had the highest attribute importance score (44.3%), followed by the ability to bundle with gender‐affirming hormone therapy services (18.7%). Minimal cost‐sharing ($0 out‐of‐pocket cost) most positively influenced the attribute importance of cost (average conjoint part‐worth utility coefficient of 2.5 [95% CI 2.4−2.6]). PrEP‐experienced respondents preferred PrEP delivery in primary care settings (relative utility score 4.7); however, PrEP‐naïve respondents preferred pharmacies (relative utility score 5.1).ConclusionsParticipants preferred programmes that offered PrEP services without cost‐sharing and bundled with gender‐affirming hormone therapy services. Bolstering federal regulations to cover PrEP services and prioritizing programmes to expand low‐barrier PrEP provision are critical to achieving equitable PrEP provision. Community‐engaged implementation research conducted by and in close collaboration with trans community stakeholders and researchers are needed to streamline the design of patient‐centred PrEP programmes and develop implementation strategies that are salient to the diverse sexual health needs of trans patients.

show abstract

Section: Discussionsupporting

confidence: 91%

HIV pre‐exposure prophylaxis programme preferences among sexually active HIV‐negative transgender and gender diverse adults in the United States: a conjoint analysis

Watson,

Listerud,

Drab

et al. 2024

J Int AIDS Soc.

View full text Add to dashboard Cite

show abstract

“…While studies explored for this review have recommended culturally sensitive interventions such as use of trusted sources such as college health nurses to interface with this demographic about PrEP and mitigate possible medical mistrust, other studies involving Black adults have recommended an integration of PrEP into gender affirming care [19,27]. Similarly, other studies amongst Blacks have advocated for the dismantling of perceived barriers to PrEP such as self-perceived HIV risk, HIV stigma, and fear of HIV disclosure which are correlates of low HIV PrEP knowledge [28]. Regarding knowledge of locations to access HIV PrEP, in one study, out of the few students (24%) who knew about HIV PrEP, 52% were unaware of the locations to access PrEP [22].…”

Section: Discussionmentioning

confidence: 99%

Knowledge, Attitudes, and Utilization of HIV PrEP among Black College Students in the United States: A Systematic Review

Obasi Odii,

Y. Byun,

E. Vance

et al. 2024

TIJPH

View full text Add to dashboard Cite

Considering the diverse socio-cultural norms, sexual attitudes, and mental and emotional immaturity that generally exist among young adults, Black college students are behaviorally vulnerable to acquiring new HIV infections before requisite exposure to HIV prevention education. Black college students (aged 18 to 34) fall within the description of one of the highest priority populations at risk for new HIV infection given the overall under-utilization and racial disparities in the HIV pre-exposure prophylaxis (PrEP) coverage among Black people in the United States (U.S). Yet, research addressing sexuality and HIV PrEP amongst Black college students are limited. This systematic review undertakes a comprehensive exploratory search of eight databases and includes four studies that have been conducted regarding Black college students HIV PrEP knowledge, attitudes and PrEP utilization in the U.S. Our findings suggest a high rate of sexual activity and hesitancy to initiate PrEP due to fear, exacerbated by low comprehensive knowledge of PrEP, low self-perceived HIV risk, and low HIV testing before any PrEP educational intervention. Positive PrEP utilization was closely associated with high self-perceived HIV risk following PrEP education, particularly when individual and structural factors were satisfactorily addressed. Current evidence suggests that PrEP is grossly under-utilized by Black college students who may benefit from it, and attitudes are driven by multiple determinants informed by psycho-social and structural barriers to PrEP access or acceptability in the U.S. Therefore, PrEP education is a potent tool for improving sexual health behaviour and attitude among Black college students.

show abstract

“…Social and structural conditions continue to drive HIV cases among Latino men who have sex with men (LMSM). Discrimination, structural stigma, social isolation, migration experiences, and cultural factors contribute to an elevated risk for many LMSM (Andriano et al, 2022; Hoebbel & Fals-Stewart, 2003; Rodriguez-Diaz et al, 2021; Shorrock et al, 2022; Stappenbeck et al, 2004; Watson et al, 2022). For instance, “machismo” norms prescribe that men must avoid feminine behaviors (e.g., being penetrated), be perceived as powerful and prove their manhood by having multiple partners and unprotected sex (Noyola et al, 2020; Rhodes et al, 2009; Robles et al, 2022; Royster et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Acceptability Pilot Test of Connecting Latinos en Parejas: A Couples-Based HIV Prevention Intervention for Latino Male Couples

et al. 2023

View full text Add to dashboard Cite

Despite recent emphasis on couples-based HIV prevention interventions, efficacious interventions for Latino male couples have yet to be tested. The study examined the feasibility and acceptability of the Connecting Latinos en Pareja (CLP) intervention, a couples-based HIV prevention intervention for Latino male couples. This pilot demonstrated high feasibility, meeting targets for recruitment, retention, and intervention completion. We recruited a diverse cohort of 46 individuals/23 couples with a retention rate of 80% over 6 months and a 100% intervention completion rate in both conditions (four structured couple sessions in each condition). This pilot RCT was not powered to detect significant intervention impact on the primary outcome; however, there was a significant increase in relationship functioning among couples in the intervention group relative to controls and promising trends in changes in several key outcome and mediating variables. Secondary analysis documented trends in the expected directions for several other key hypothesized mechanisms of action (stimulant use, psychological symptoms, quality of life) as well as the primary outcome of proportion of protected sex acts (overall and broken out by main vs. outside partners). Qualitative exit interviews revealed high levels of acceptability of the CLP intervention. Participants highlighted affective component of the intervention and perceived effectiveness in improving dyadic communication skills and safer sex practices. Our findings show that a pilot trial of CLP is highly feasible and acceptable, with CLP demonstrating promising evidence of changes in key intervention mechanisms.

show abstract

Dismantling Barriers and Transforming the Future of Pre-Exposure Prophylaxis Uptake in Young Black and Latinx Sexual Minority Men and Transgender Women

Cited by 12 publications

References 49 publications

HIV pre‐exposure prophylaxis programme preferences among sexually active HIV‐negative transgender and gender diverse adults in the United States: a conjoint analysis

HIV pre‐exposure prophylaxis programme preferences among sexually active HIV‐negative transgender and gender diverse adults in the United States: a conjoint analysis

Knowledge, Attitudes, and Utilization of HIV PrEP among Black College Students in the United States: A Systematic Review

Feasibility and Acceptability Pilot Test of Connecting Latinos en Parejas: A Couples-Based HIV Prevention Intervention for Latino Male Couples

Contact Info

Product

Resources

About