Structural and syndemic barriers to PrEP adoption among Black women at high risk for HIV: a qualitative exploration

Nydegger, Liesl A.; Dickson‐Gómez, Julia; Ko, Thant Ko

doi:10.1080/13691058.2020.1720297

Cited by 59 publications

(48 citation statements)

References 38 publications

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“…For example, women who are focused on finding a safe place to sleep at night or obtaining food for themselves and their families, may not have time to devote to PrEP appointments. Therefore, it is important to offer other needed resources along with PrEP in order to engage women throughout the PrEP care continuum [ 71 , 72 ]. Importantly, our findings suggest that providing referrals to PrEP and other services are not enough.…”

Section: Discussionmentioning

confidence: 99%

Considerations for the Design of Pre-exposure Prophylaxis (PrEP) Interventions for Women: Lessons Learned from the Implementation of a Novel PrEP Intervention

et al. 2021

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Pre-exposure prophylaxis (PrEP) uptake among women in the United States has been low. To increase uptake, we developed a peer outreach and navigation PrEP intervention. Semi-structured qualitative interviews with 32 cisgender women and 3 transgender women were conducted to assess the intervention. We used a thematic approach to identify barriers to, and facilitators of the intervention. Facilitators included interest in PrEP, offer of health and social services, the intervention’s women-focused approach, and peer outreach and navigation. Barriers were perceived HIV risk, concerns about medication side effects or interactions, housing insecurity and travel, co-occurring health-related conditions, and caregiving responsibilities. We recommend that future interventions consider packaging PrEP in local community settings, such as syringe exchange programs; include services such as food and housing assistance; use peers to recruit and educate women; integrate a culturally appropriate women’s focus; and consider providing same-day PrEP.

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Section: Discussionmentioning

confidence: 99%

Considerations for the Design of Pre-exposure Prophylaxis (PrEP) Interventions for Women: Lessons Learned from the Implementation of a Novel PrEP Intervention

et al. 2021

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“…Finally, we found that Black ciswomen were very engaged in the PrEP decision-making process. Together this suggests that increasing community awareness of PrEP among Black ciswomen, as well as non-judgmental PrEP education in the clinic, could improve uptake and persistence [ 13 , 14 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Themes of trust, safety, and family frequently came up regarding PrEP and should be further explored to develop culturally appropriate and inclusive messages [ 6 , 34 ]. In addition, one participant clearly outlined the need to provide support groups for ciswomen to discuss their experience, preferably outside of an HIV clinic, also reflected in the literature [ 24 ]. As peers have often been used in HIV treatment, this may be an effective strategy for HIV prevention as well [ 24 , 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

HIV Pre-exposure Prophylaxis Use and Persistence among Black Ciswomen: “Women Need to Protect Themselves, Period”

Pyra

Johnson

Devlin

et al. 2021

J. Racial and Ethnic Health Disparities

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Background Disparities in HIV incidence and PrEP use among Black ciswomen remain. We examine factors associated with PrEP persistence using mixed methods. Setting Black ciswomen in Chicago, IL, prescribed PrEP at a federally qualified health center (FQHC). Methods We used electronic health data to determine PrEP persistence (Proportion of Days Covered ≥86% at 6 months) and tested demographic and clinical factors in logistic regressions. We interviewed eight Black ciswomen, purposefully selected by PrEP persistence. Results Among 112 Black ciswomen, 18% were persistent. In adjusted models, neighborhood, visit reason (at initiation), and initiation year were significantly associated with persistence. Qualitatively, we found little evidence of cost or adherence as barriers; participants reported low community awareness, importance of providers, and concerns around stigma, side effects, and pregnancy while using PrEP. Conclusion While persistence among Black ciswomen was low, patients were often making decisions based on perceived HIV risk. We identified real-world barriers to address in future interventions.

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“…The intersecting stigma of social identities or behaviors with HIV further stigmatizes individuals of social groups, such as racial/ethnic minorities (Stangl et al, 2019). Intersectional stigma and discrimination lead African Americans to avoid engaging in the HIV continuum of care; they may be less likely to get tested for HIV, adopt pre-exposure prophylaxis, attend appointments, and/or adhere to medication (Eaton et al, 2017; Murray and Oraka, 2014; Nydegger et al, 2020; Rao et al, 2018; Rice et al, 2018; Stangl et al, 2019). Social inequities increase health disparities and lead to increased rates of chronic diseases, including HIV/AIDS, which increases the risk and severity of COVID-19.…”

Section: Barriers To Healthcarementioning

confidence: 99%

“…They are less likely to receive HIV-related treatment. When treatment is provided, the quality is poor – controlling for other demographics – and they receive fewer diagnostic procedures and medications, further elevating their risk of morbidity or mortality (El-Bassel et al, 2009; Nydegger et al, 2020; Rice et al, 2018) and transmitting HIV to others. Medical mistrust among African Americans due to historical mistreatment (e.g.…”

Section: Barriers To Healthcarementioning

confidence: 99%

Examining COVID-19 and HIV: The impact of intersectional stigma on short- and long-term health outcomes among African Americans

Nydegger

Hill

2020

International Social Work

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The COVID-19 pandemic has exacerbated the health disparities and structural racism among African Americans. We examined overlaps between the COVID-19 pandemic and HIV epidemic using an intersectional stigma framework through the lens of Critical Race Theory. Intersectional stigma, medical mistrust, and decreased likelihood of referral for HIV and COVID-19 testing leads to decreased engagement in the healthcare system. Social inequities increase health disparities and lead to increased rates of chronic diseases, which increases the risk and severity of COVID-19. Solutions to mitigate impact among African Americans include increasing engagement regarding African American health, funding, and providers of color.

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Structural and syndemic barriers to PrEP adoption among Black women at high risk for HIV: a qualitative exploration

Cited by 59 publications

References 38 publications

Considerations for the Design of Pre-exposure Prophylaxis (PrEP) Interventions for Women: Lessons Learned from the Implementation of a Novel PrEP Intervention

Considerations for the Design of Pre-exposure Prophylaxis (PrEP) Interventions for Women: Lessons Learned from the Implementation of a Novel PrEP Intervention

HIV Pre-exposure Prophylaxis Use and Persistence among Black Ciswomen: “Women Need to Protect Themselves, Period”

Examining COVID-19 and HIV: The impact of intersectional stigma on short- and long-term health outcomes among African Americans

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