Using an Intersectional Framework to Understand the Challenges of Adopting Pre-exposure Prophylaxis (PrEP) Among Young Adult Black Women

Bond, Keosha T.; Gunn, Alana; Williams, Porche; Leonard, Noelle R.

doi:10.1007/s13178-021-00533-6

Cited by 30 publications

(29 citation statements)

References 66 publications

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“…Empowering Black women to make informed, autonomous decisions within their healthcare may help increase PrEP initiation: Guided by intersectionality, [23][24][25] the present study assessed sociostructural in uences on PrEP deliberation and initiation among Black women. Consistent with prior research, 17,31,32 In recent years, HIV prevention researchers have called for research on structural contexts, [33][34][35][36] and Black women in our study described three key structural barriers to PrEP consideration and initiation: costs; limited speci c marketing; and medical distrust. Financial costs have been documented as a deterrent, 32,37 but structural mechanisms such as racial-and gender-related wage gaps 38 and gendered racism 39 have contributed to economic inequalities experienced by Black women.…”

Section: Barriers Of Prep Deliberationsupporting

confidence: 81%

“…Their general skepticism in conjunction with experiences of provider bias contributes to medical mistrust and distrust in the healthcare system. Consistent with prior research on PrEP initiation among Black women, 31,32 limited PrEP awareness and low perceived risk perception for HIV acquisition appeared to delay PrEP initiation. Speci cally, Black women who believe they are at low risk for acquiring HIV may view PrEP as unnecessary and thus view themselves as inappropriate candidates for PrEP.…”

Section: Barriers Of Prep Deliberationsupporting

confidence: 79%

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Where’S the “Everyday Black Woman”? an Intersectional Qualitative Analysis of Black Women’S Decision-Making Regarding HIV Pre-Exposure Prophylaxis (PrEP) in Mississippi

Willie

Knight

Baral

et al. 2021

Preprint

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Background Black cisgender women in the U.S. South bear a disproportionate burden of HIV compared to cisgender women in other racial and ethnic groups and in any other part of the US. Critical to decreasing new HIV infections is the improved delivery of pre-exposure prophylaxis (PrEP) for Black cisgender women as it remains underutilized in 2021. Informed by intersectionality, the study sought to characterize the sociostructural influences on Black cisgender women’s deliberations about PrEP within the context of interlocking systems of oppression including racism, sexism, and classism. Methods Six focus groups were conducted with 37 Black women residing in Jackson, Mississippi. This sample was purposively recruited to include Black cisgender women who were eligible for PrEP but had never received a PrEP prescription. Results Six themes were identified as obstacles during PrEP deliberation among Black women: 1) limited PrEP awareness, 2) low perceived HIV risk, 3) concerns about side effects, 4) concerns about costs, 5) limited marketing, and 6) distrust in the healthcare system. Three themes were identified as facilitators during PrEP deliberations: 1) women’s empowerment and advocacy, 2) need for increased PrEP-specific education, and 3) the positive influence of PrEP-engaged women’s testimonials. Black women shared a limited awareness of PrEP exacerbated by the lack of Black women-specific marketing. Opportunities to support Black women-specific social marketing could increase awareness and knowledge regarding PrEP’s benefits and costs. Black women also shared their concerns about discrimination in healthcare and distrust, but they felt that these barriers may be addressed by patient testimonials from PrEP-engaged Black women, empowerment strategies, and directly addressing provider biases. Conclusions An effective response to PrEP implementation among Black women in the South requires developing programs to center the needs of Black women and carry out active strategies that prioritize peer advocacy while reinforcing positive and mitigating negative influences from broader social and historical contexts.

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Section: Barriers Of Prep Deliberationsupporting

confidence: 81%

Section: Barriers Of Prep Deliberationsupporting

confidence: 79%

Where’S the “Everyday Black Woman”? an Intersectional Qualitative Analysis of Black Women’S Decision-Making Regarding HIV Pre-Exposure Prophylaxis (PrEP) in Mississippi

Willie

Knight

Baral

et al. 2021

Preprint

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“…For example, Black women and their communities have experienced violence, discrimination, stigma, and poverty that have disrupted sexual networks, relationship power dynamics and thus thwarted HIV prevention efforts [ 26 , 27 ]. Despite recent calls to address socio-structural factors and PrEP care [ 18 , 30 ], few studies have conceptualized Black women’s experiences related to PrEP within an intersectional framework. Historically rooted in Black feminist theory, intersectionality is a theoretical framework that posits macro-level factors (e.g., racism, sexism, classism) produce multiple interlocking sources of oppression and power, which intersect and impact individuals at the micro-level based on their social identities [ 31 – 34 ].…”

Section: Introductionmentioning

confidence: 99%

“PrEP’s just to secure you like insurance”: a qualitative study on HIV pre-exposure prophylaxis (PrEP) adherence and retention among black cisgender women in Mississippi

Willie

Monger²,

Nunn

et al. 2021

BMC Infect Dis

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Background Pre-exposure prophylaxis (PrEP) has the potential to reduce transmission of HIV among Black cisgender women in the Southern United States (U.S.); however, national data suggests that PrEP initiation is lowest in the South and among Black women compared to other U.S. regions and white women. This study applied intersectionality and PrEP multilevel resilience frameworks to assess how socio-structural and clinical contexts shaped PrEP persistence among Black cisgender women in Mississippi. Methods Semi-structured interviews were conducted with eight Black cisgender women in Jackson, Mississippi. This sample was purposively recruited to include PrEP-initiated Black cisgender women. Results Six themes identified that shaped PrEP care among Black cisgender women: (1) internal assets, (2) sole responsibility to HIV prevention, (3) added protection in HIV serodifferent relationships, (4) financial issues, (5) trust and distrust in the medical system, and (6) side effects. Black cisgender women reported that PrEP persistence increased control over their sexual health, reduced anxiety about HIV, and promoted self-care. Black cisgender women also indicated that medication assistance programs increased PrEP affordability resulting in continued persistence. Conclusions In addition to preventing HIV, PrEP may yield secondary positive impacts on the health and relationships of Black cisgender women. However, very few Black cisgender women in the South are using PrEP given intersectional barriers and thus necessitates adaptive strategies to support PrEP initiation and persistence. Efforts aimed at increasing the coverage of PrEP among Black cisgender women should consider implementation strategies responsive to lived realities of Black women.

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“…However, these actions are not enough. There is a need to incorporate justice paradigms [37], including insights from intersectional feminism and critical race theory [9,[38][39][40], within HIV prevention science to account for the dynamics of power and exploitation that foster inequities embedded within research and better engage with community values on what it means for science to be trustworthy.…”

Section: Paradox 3: Are We Just Guinea Pigs?mentioning

confidence: 99%

The wisdom of mistrust: qualitative insights from transgender women who participated in PrEP research in Lima, Peru

Perez-Brumer

Naz-McLean

Huerta³

et al. 2021

J Int AIDS Soc.

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Introduction: Although pre-exposure prophylaxis (PrEP) is a remarkable biomedical advance to prevent HIV, ongoing research on PrEP contributes to and interacts with a legacy of HIV experimentation on marginalized communities in resource-limited settings. This paper explores the complexity of PrEP research mistrust among Peruvian transgender (trans) women who completed a PrEP adherence intervention and those who refused participation (i.e. declined to enrol, voluntarily withdrew, and/or were lost to follow-up). Methods: Data were derived from 86 trans women (mean age 29 years) participants in the formative (four focus groups (n = 32), 20 interviews) and the evaluation stages (34 interviews) of a social network-based PrEP intervention for trans women in Lima, Peru. The formative stage took place from May to July 2015, while the evaluative stage took place from April to May 2018. Audio files were transcribed verbatim and analysed via an immersion crystallization approach using Dedoose (v.6.1.18). Results: Three paradoxes of trans women's participation in PrEP science as a "key" population emerged as amplifying mistrust:(1) increases in PrEP research targeting trans women but limited perceived improvements in HIV outcomes; (2) routine dismissal by research physicians and staff of PrEP-related side effects and the social realities of taking PrEP, resulting in questions about who PrEP research is really for and (3) persistent limitations on PrEP access for trans women despite increasing involvement in clinical trials, fostering feelings of being a "guinea pig" to advance PrEP science. Conclusions: Findings highlight the wisdom inherent in PrEP mistrust as a reflection of trans women's experiences that underscore the broken bonds of trust between communities, researchers and the research enterprise. PrEP mistrust is amplified through perceived paradoxes that suggest to trans women that they are key experimental participants but not target PrEP users outside of research settings. Findings highlight the urgent need to reframe mistrust not as a characteristic of trans women to be addressed through education and outreach, but as a systemic institutional-and industry-level problem replicated, manifested and ultimately to be corrected, through global HIV science.

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Using an Intersectional Framework to Understand the Challenges of Adopting Pre-exposure Prophylaxis (PrEP) Among Young Adult Black Women

Cited by 30 publications

References 66 publications

Where’S the “Everyday Black Woman”? an Intersectional Qualitative Analysis of Black Women’S Decision-Making Regarding HIV Pre-Exposure Prophylaxis (PrEP) in Mississippi

Where’S the “Everyday Black Woman”? an Intersectional Qualitative Analysis of Black Women’S Decision-Making Regarding HIV Pre-Exposure Prophylaxis (PrEP) in Mississippi

“PrEP’s just to secure you like insurance”: a qualitative study on HIV pre-exposure prophylaxis (PrEP) adherence and retention among black cisgender women in Mississippi

The wisdom of mistrust: qualitative insights from transgender women who participated in PrEP research in Lima, Peru

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