The “Safe Sex” Conundrum: Anticipated Stigma From Sexual Partners as a Barrier to PrEP Use Among Substance Using MSM Engaging in Transactional Sex

Biello, Katie B.; Oldenburg, Catherine E.; Mitty, Jennifer A.; Closson, Elizabeth F.; Mayer, Kenneth H.; Safren, Steven A.; Mimiaga, Matthew J.

doi:10.1007/s10461-016-1466-y

Cited by 72 publications

(50 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…“Anticipated stigma” includes fears about others’ negative reactions to PrEP, while “experienced stigma” describes first‐hand experience of stigma resulting from PrEP use . 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

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…To best understand PrEP stigma and the ways in which it impacts PrEP decision-making, standardized and validated measurement tools are needed. Past quantitative measurements of PrEP stigma have predominantly consisted of individual belief statements, with each belief statement then assessed for association with PrEP-related outcomes such as willingness to take PrEP [14,20,21]. Such items are diverse in content and wording, as well as response format, with some using semantic differential options (unpleasant ….. pleasant) [22] and others using Likert scale options (strongly disagree, disagree, neutral, agree, strongly agree).…”

Section: Introductionmentioning

confidence: 99%

Validation of the HIV Pre-exposure Prophylaxis Stigma Scale: Performance of Likert and Semantic Differential Scale Versions

et al. 2020

Self Cite

View full text Add to dashboard Cite

Stigma regarding HIV pre-exposure prophylaxis (PrEP) is commonly implicated as a factor limiting the scale-up of this highly effective HIV prevention modality. To quantify and characterize PrEP stigma, we developed and validated a brief HIV PrEP Stigma Scale (HPSS) among a group of 279 men who have sex with men (MSM). Scale development was informed by a theoretical model to enhance content validity. We assessed two scale versions, Semantic Differential and Likert, randomizing the order in which scales were presented to participants. Both scales demonstrated high internal consistency. The Likert scale had substantially better construct validity and was selected as the preferred option. Scale scores demonstrated construct validity through association with constructs of interest: healthcare distrust, HIV knowledge, perceived proportion of friends/partners on PrEP, perceived community evaluation of PrEP, and perceived effectiveness of PrEP. The scale accounted for 25% of the total variance in reported willingness to be on PrEP, indicating the substantial role PrEP stigma may have on decisions to initiate PrEP. Given increased efforts to roll-out PrEP, having a valid tool to determine the level and types of PrEP stigma in individuals, groups, and communities can help direct implementation plans, identify goals for stigma reduction, and monitor progress over time.

show abstract

“…MSM may underestimate their risk of getting HIV, and may therefore see themselves as not requiring PrEP (Blumenthal et al, 2019;Parsons et al, 2017). Other barriers for PrEP uptake may include medical mistrust and anticipated stigma from sex partners (Biello et al, 2017;Cahill et al, 2017;Golub, 2018). To promote PrEP uptake, it is essential to further examine factors related to interest in PrEP in populations for whom PrEP implementation should be fostered.…”

Section: Introductionmentioning

confidence: 99%

PrEP Interest Among Men Who Have Sex with Men in the Netherlands: Covariates and Differences Across Samples

Dijk

Duken

Delabre³

et al. 2020

Arch Sex Behav

View full text Add to dashboard Cite

Despite increased availability of pre-exposure prophylaxis (PrEP), PrEP uptake has remained low. To promote uptake, factors related to PrEP interest among relevant target populations warrant investigation. The aim of this study was to provide an analysis of PrEP interest among men who have sex with men (MSM) in the Netherlands, while taking study recruitment strategies into account. We recruited 154 MSM from an LGBT research panel (AmsterdamPinkPanel) and 272 MSM from convenience sampling. Both samples were part of the Flash! PrEP in Europe Survey and were compared on their PrEP interest, usage intentions, and sexual behavior. We conducted logistic regression analyses to discover variables associated with PrEP interest and intentions. Participants from the AmsterdamPinkPanel were less likely to use PrEP, had less knowledge of PrEP, and were less interested in PrEP than participants from convenience sampling. Significant covariates of PrEP interest were being single, more prior PrEP knowledge, sexual risk behaviors, such as not having used a condom during last sex and having ever used drugs in a sexual context, and not participating in the AmsterdamPinkPanel. Adding the recruitment strategy to the regression increased explained variance on top of predictors already described in the literature. Increased sexual risk behavior is related to increased PrEP interest and it helps to identify PrEP target groups. Recruitment strategies have a substantial impact on findings regarding PrEP interest and usage intentions. This study emphasizes the importance of using multiple strategies for recruiting participants to obtain a more comprehensive view of MSM's attitudes toward PrEP.

show abstract

The “Safe Sex” Conundrum: Anticipated Stigma From Sexual Partners as a Barrier to PrEP Use Among Substance Using MSM Engaging in Transactional Sex

Cited by 72 publications

References 24 publications

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

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

Validation of the HIV Pre-exposure Prophylaxis Stigma Scale: Performance of Likert and Semantic Differential Scale Versions

PrEP Interest Among Men Who Have Sex with Men in the Netherlands: Covariates and Differences Across Samples

Contact Info

Product

Resources

About