Perceptions of HIV Pre-Exposure Prophylaxis Among Young, Black Men Who Have Sex with Men

Abstract

We conducted in-depth interviews guided by the Andersen-Newman Health Service Utilization Framework to understand perceptions of pre-exposure prophylaxis (PrEP) with 25 young, black men who have sex with men (YBMSM) in the Southern United States. The mean age of participants was 24 years; 21 were insured; and 18 had a regular source of care. Five major themes emerged: (i) stigma related to being black, gay and living in the South; (ii) lack of discussion in the black community about HIV prevention and sexual health; (iii) stigma related to PrEP; (iv) medical mistrust; and (v) low perceived need to be on PrEP. This study presents formative qualitative work that underscores the need for behavioral interventions to address intersectional stigma and perceptions of risk among YBMSM in the South, so that PrEP is no longer viewed as a drastic step but rather as a routine HIV prevention strategy.

HIV Preexposure Prophylaxis and Treatment as Prevention — Beliefs and Access Barriers in Men Who Have Sex with Men (MSM) and Transgender Women: A Systematic Review

“…Despite the benefits of the internet and online groups, seeking information about PrEP and eligibility can be difficult for those residing in communities where stigma is high and LGBT-targeted resources are scarce. 19 For those with some PrEP awareness, insufficient knowledge led to inaccurate beliefs about PrEP or unaddressed concerns. Some concerns and beliefs documented in the literature were fear that PrEP use would result in increased high-HIV-risk behaviors, belief that serious long-term consequences from PrEP use would occur, belief that PrEP was limited to serodiscordant couples, and concerns that antiretroviral drugs used as PrEP would no longer work in the case of seroconversion.…”

“…This stigma prevents the initiation of important discussions about HIV prevention and sexual health as well as the correction of negative beliefs held by some that PrEP is for sexually promiscuous people or will cause an increase in risky sexual behavior. 19,35 Some MSM and transgender women who have sex with men hold PrEP-related stigma along with conspiracyrelated beliefs arising from mistrust with government entities and the pharmaceutical industry. 35 While some MSM associate PrEP with sexual promiscuity, others fear rejection and discrimination from potential sex partners should they disclose their use of PrEP.…”

“…22 For black MSM, PrEP-related stigma is exacerbated by the complexity of reconciling their selfconstructed meaning about being black, gay, and living in the South, with public health messaging around HIV as a social problem. 19 Individuals with multiple stigmatizing identities are aware of their invisibility to others and the existence of discrimination and negative stereotypes. Professionals working with black MSM must support their patients' efforts to untangle the internalized stigma associated with each identity and realize a self-identity that is free from guilt and shame.…”

Youth‐friendly services and a mobile phone application to promote adherence to pre‐exposure prophylaxis among adolescent men who have sex with men and transgender women at‐risk for HIV in Thailand: a randomized control trial

“…Adolescents and young men who have sex with men (YMSM) and young transgender women (YTGW) bear disproportionate burdens of HIV globally [1‐4]. In Thailand, the HIV incidence among YMSM/YTGW has been consistently high, reported at 4 to 11 per 100 person years [3‐7], similar to the United States where an estimated 14% of TGW are living with HIV (US CDC 2019) and over a third of all new HIV infections are in YMSM [8,9]. The Thai epidemic among YMSM and YTGW is perpetuated by low rates of HIV test uptake, poor HIV knowledge and rates of condom use below 50% [10,11].…”

Human Immunodeficiency Virus in the State of Texas of the United States: Past Reflections, Present Shortcomings, and Future Needs of the Public Health Response

“…However, several challenges remain pervasive. There is still substantial HIV stigma in the South [ 76 ], more recently evolving into stigma against biomedical prevention tools, such as PrEP [ 77 ]. Social determinants of health continue to drive HIV-related disparities [ 56 ].…”