Stigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention: A Qualitative Study

Dubov, Alex; Galbo, Phillip M.; Altice, Frederick L.; Fraenkel, Liana

doi:10.1177/1557988318797437

Cited by 165 publications

(139 citation statements)

References 47 publications

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“…However, some participants reported decreased condom use after PrEP initiation, and in some cases it was reported that HCWs had recommended this for clients in stable marriages. While other research has shown that stereotypes of promiscuity were a deterrent to taking PrEP in the United States [37], this issue was not raised in the Zimbabwean setting.…”

Section: Discussionmentioning

confidence: 87%

Key barriers and enablers associated with uptake and continuation of oral pre-exposure prophylaxis (PrEP) in the public sector in Zimbabwe: Qualitative perspectives of general population clients at high risk for HIV

Gombe¹,

Cakouros²,

Ncube

et al. 2020

PLoS ONE

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BackgroundUnderstanding the perspectives and preferences of clients eligible for pre-exposure prophylaxis (PrEP) is essential to designing programs that meet clients' needs. To date, most PrEP programs in limited-resource settings have been implemented by partner organizations for specific target populations, but the government of Zimbabwe aims to make PrEP available to the broader population at substantial risk in public sector clinics. However, there is limited information on general population perspectives about PrEP in Zimbabwe.

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Section: Discussionmentioning

confidence: 87%

Key barriers and enablers associated with uptake and continuation of oral pre-exposure prophylaxis (PrEP) in the public sector in Zimbabwe: Qualitative perspectives of general population clients at high risk for HIV

Gombe¹,

Cakouros²,

Ncube

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…It may also be stigma relating specifically to PrEP. The latter is largely attributable to ''PrEP shaming''-the belief that PrEP users engage in reckless sexual behavior-and was a topic of much debate following the labeling of PrEP users as ''Truvada whores'' in 2012 [51,52]. The evidence summarized in Table 5 suggests that PrEP stigma persists: participants from several studies reported experience of PrEP-related stigma that manifested in a number of ways, including stereotyping, rejection, and discrimination (including homophobia, transphobia, racism, and sexism), all of which were identified as barriers to PrEP use ( Table 5).…”

Section: Social Stigma As a Barrier To Prep Uptakementioning

confidence: 99%

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

2020

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Antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV transmission was first approved by the US Food and Drug Administration in 2012. Despite correlations of decreases in new HIV infections being greatest where PrEP has been deployed, the uptake of PrEP is lagging, particularly among populations with disproportionate HIV burden. This narrative review seeks to identify individual and systemic barriers to PrEP usage in the USA. A comprehensive search of recent literature uncovered a complex array of structural, social, clinical, and behavioral barriers, including knowledge/awareness of PrEP, perception of HIV risk, stigma from healthcare providers or family/partners/friends, distrust of healthcare providers/systems, access to PrEP, costs of PrEP, and concerns around PrEP side effects/medication interactions. Importantly, these barriers may have different effects on specific populations at risk. The full potential of PrEP for HIV prevention will not be realized until these issues are addressed. Strategies to achieve this goal should include educational interventions, innovative approaches to delivery of HIV care, financial support, and destigmatization of PrEP and PrEP users. Until then, PrEP uptake will continue to be suboptimal, particularly among those who need it most.

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“…PrEP has been stigmatized because antiretrovirals with the same appearance are used for HIV treatment, and PrEP users may be mistakenly labeled as “HIV positive” . PrEP may also be seen as promoting sexual promiscuity, leading to stigma related to norms around sexuality in adolescent girls and young women (AGYW) .…”

Section: Introductionmentioning

confidence: 99%

The influence of HIV‐related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082: a qualitative study

et al. 2020

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Introduction Stigma and disclosure concerns have been key barriers to oral pre‐exposure prophylaxis (PrEP) adherence for African adolescent girls and young women (AGYW) in efficacy trials. We aimed to understand the impact of these factors among African AGYW in an open‐label PrEP study. Methods HPTN 082 was an open‐label PrEP study among AGYW (ages 16 to 24) in Harare, Zimbabwe, and Cape Town and Johannesburg, South Africa from 2016 to 2018. Women starting PrEP were randomized to standard adherence support (counselling, two‐way SMS, monthly adherence clubs) or standard support plus drug‐level feedback. Serial in‐depth interviews were conducted among 67 AGYW after 13‐week and 26‐week study visits to explore experiences of stigma, disclosure and PrEP adherence. We analysed data by coding transcripts and memo‐writing and diagramming to summarize themes. Results AGYW described stigma related to sexual activity (e.g. “people say I'm a prostitute”) and being perceived to be living with HIV because of taking antiretrovirals (e.g. “my husband's friends say I'm HIV infected”). Participants who anticipated stigma were reluctant to disclose PrEP use and reported adherence challenges. Disclosure also resulted in stigmatizing experiences. Across all sites, negative descriptions of stigma and disclosure challenges were more common in the first interview. In the second interview, participants often described disclosure as an “empowering” way to combat community‐level PrEP stigma; many said that they proactively discussed PrEP in their communities (e.g. became a “community PrEP ambassador”), which improved their ability to take PrEP and encourage others to use PrEP. These empowering disclosure experiences were facilitated by ongoing HPTN 082 study activities (e.g. counselling sessions, adherence clubs) in which they could discuss PrEP‐related stigma, disclosure and PrEP adherence issues. Conclusions Stigma and disclosure challenges were initial concerns for African AGYW newly initiating PrEP but many were empowered to disclose PrEP use over their first six months of PrEP use, which helped them cope with stigma and feel more able to take PrEP regularly. PrEP programmes can foster disclosure through community and clinic‐based discussion, adherence clubs and activities normalizing sexual behaviour and PrEP use, which can reduce stigma and improve PrEP adherence and thus effectiveness.

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Stigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention: A Qualitative Study

Cited by 165 publications

References 47 publications

Key barriers and enablers associated with uptake and continuation of oral pre-exposure prophylaxis (PrEP) in the public sector in Zimbabwe: Qualitative perspectives of general population clients at high risk for HIV

Key barriers and enablers associated with uptake and continuation of oral pre-exposure prophylaxis (PrEP) in the public sector in Zimbabwe: Qualitative perspectives of general population clients at high risk for HIV

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

The influence of HIV‐related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082: a qualitative study

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