Skip to main content

Advertisement

Log in

Correlates of PrEP Uptake Among Young Sexual Minority Men and Transgender Women in New York City: The Need to Reframe “Risk” Messaging and Normalize Preventative Health

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Pre-exposure prophylaxis (PrEP) is an effective form of HIV prevention, but young sexual minority men face myriad barriers to PrEP uptake. Participants (n = 202) completed a survey on healthcare experiences and beliefs about HIV and PrEP. While 98% of the sample knew about PrEP, only 23.2% reported currently taking PrEP. Participants were more likely to be taking PrEP if they received PrEP information from a healthcare provider and endorsed STI-related risk compensation. Conversely, PrEP uptake was less likely among those with concerns about medication use and adherence. While there were no racial/ethnic differences in PrEP uptake, there were differences in correlates of PrEP use for White participants and participants of color. To facilitate PrEP uptake, clinicians should provide PrEP education and screen all patients for PrEP candidacy. Additionally, public health messaging must reframe HIV “risk”, highlight benefits of STI testing, and emphasize the importance of preventive healthcare for SMM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Gray ME, Shenoi SV, Dillingham R. Pre-exposure prophylaxis as HIV prevention in high risk adolescents. J Pediatr Pediatr Med. 2018;2(1):5.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Centers for Disease Control and Prevention. Diagnoses of HIV Infection in the United States and Dependent Areas, 2018 (Updated). 2018;31. http://www.cdc.gov/hiv/surveillance/resources/reports/2009report/index.htm#1.

  4. Goodreau SM, Hamilton DT, Jenness SM, Sullivan PS, Valencia RK, Wang LY, et al. Targeting human immunodeficiency virus pre-exposure prophylaxis to adolescent sexual minority males in higher prevalence areas of the United States: a modeling study. J Adolesc Heal [Internet]. 2018;62(3):311–9. https://doi.org/10.1016/j.jadohealth.2017.09.023.

    Article  Google Scholar 

  5. Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214–22.

    Article  PubMed  Google Scholar 

  6. D’Avanzo PA, Bass SB, Brajuha J, Gutierrez-Mock L, Ventriglia N, Wellington C, et al. Medical mistrust and PrEP perceptions among transgender women: a cluster analysis. Behav Med. 2019;45(2):143–52.

    Article  PubMed  Google Scholar 

  7. Thomann M, Grosso A, Zapata R, Chiasson MA. ‘WTF is PrEP?’: attitudes towards pre-exposure prophylaxis among men who have sex with men and transgender women in New York City. Cult Heal Sex. 2018;20(7):772–86.

    Article  Google Scholar 

  8. Centers for Disease Control and Prevention. HIV prevention pill not reaching most Americans who could benefit—especially people of color. Atlanta: Centers for Disease Control and Prevention; 2018.

    Google Scholar 

  9. Finlayson T, Cha S, Xia M, Trujillo L, Denson D, Prejean J, et al. Changes in HIV preexposure prophylaxis awareness and use among men who have sex with men—20 urban areas, 2014 and 2017. Morb Mortal Wkly Rep [Internet]. 2019;68:597.

    Article  Google Scholar 

  10. Frazer E, Mitchell RA Jr, Nesbitt LS, Williams M, Mitchell EP, Williams RA, et al. The violence epidemic in the African American community: a call by the National Medical Association for comprehensive reform. J Natl Med Assoc. 2018;110(1):4–15.

    PubMed  Google Scholar 

  11. Bogart LM, Dale SK, Christian J, Patel K, Daffin GK, Mayer KH, et al. Coping with discrimination among HIV-positive Black men who have sex with men. Cult Health Sex. 2017;19(7):723–37.

    Article  PubMed  Google Scholar 

  12. Wood S, Gross R, Shea JA, Bauermeister JA, Franklin J, Petsis D, et al. Barriers and facilitators of PrEP adherence for young men and transgender women of color. AIDS Behav. 2019;23(10):2719–29.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson D, Mayer KH. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care. 2017;29(11):1351–8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Griffin M, Jaiswal J, King D, Singer SN, Halkitis PN. Sexuality disclosure, trust, and satisfaction with primary care among urban young adult sexual minority men. J Nurse Pract. 2020;16:378–87.

    Article  Google Scholar 

  15. Knight RE, Shoveller JA, Carson AM, Contreras-Whitney JG. Examining clinicians’ experiences providing sexual health services for LGBTQ youth: considering social and structural determinants of health in clinical practice. Health Educ Res. 2014;29(4):662–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Wylie K, Knudson G, Khan SI, Bonierbale M, Watanyusakul S, Baral S. Serving transgender people: clinical care considerations and service delivery models in transgender health. Lancet. 2016;388(10042):401–11.

    Article  PubMed  Google Scholar 

  17. Wamsley L. California to make HIV prevention drugs available without a prescription. Guam: National Public Radio; 2019.

    Google Scholar 

  18. Krakower DS, Mayer KH. The role of healthcare providers in the roll-out of PrEP. Curr Opin HIV AIDS. 2016;11(1):41.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Blumenthal J, Jain S, Krakower D, Sun X, Young J, Mayer K, et al. Knowledge is power! Increased provider knowledge scores regarding pre-exposure prophylaxis (PrEP) are associated with higher rates of PrEP prescription and future intent to prescribe PrEP. AIDS Behav. 2015;19(5):802–10.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Seidman D, Carlson K, Weber S, Newmann S, Witt J. Family planning providers’ knowledge of and attitudes toward preexposure prophylaxis for HIV prevention: a national survey. Contraception. 2015;92(4):411.

    Article  Google Scholar 

  21. Turner L, Roepke A, Wardell E, Teitelman AM. Do you PrEP? A review of primary care provider knowledge of PrEP and attitudes on prescribing PrEP. J Assoc Nurses AIDS Care. 2018;29(1):83–92.

    Article  PubMed  Google Scholar 

  22. Fallon SA, Park JN, Ogbue CP, Flynn C, German D. Awareness and acceptability of pre-exposure HIV prophylaxis among men who have sex with men in Baltimore. AIDS Behav. 2017;21(5):1268–77.

    Article  PubMed  Google Scholar 

  23. Hoffman S, Guidry JA, Collier KL, Mantell JE, Boccher-Lattimore D, Kaighobadi F, et al. A clinical home for preexposure prophylaxis: diverse health care providers’ perspectives on the “purview paradox.” J Int Assoc Provid AIDS Care. 2016;15(1):59–65.

    Article  PubMed  Google Scholar 

  24. Silapaswan A, Krakower D, Mayer KH. Pre-exposure prophylaxis: a narrative review of provider behavior and interventions to increase PrEP implementation in primary care. J Gen Intern Med. 2017;32(2):192–8.

    Article  PubMed  Google Scholar 

  25. Calabrese SK, Magnus M, Mayer KH, Krakower DS, Eldahan AI, Hawkins LAG, et al. “Support your client at the space that they’re in”: HIV pre-exposure prophylaxis (PrEP) prescribers’ perspectives on PrEP-related risk compensation. AIDS Patient Care STDS. 2017;31(4):196–204.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Newcomb ME, Moran K, Feinstein BA, Forscher E, Mustanski B. Pre-exposure prophylaxis (PrEP) use and condomless anal sex: evidence of risk compensation in a cohort of young men who have sex with men. J Acquir Immune Defic Syndr. 2018;77(4):358.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Storholm ED, Volk JE, Marcus JL, Silverberg MJ, Satre DD. Risk perception, sexual behaviors, and PrEP adherence among substance-using men who have sex with men: a qualitative study. Prev Sci. 2017;18(6):737–47.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hojilla JC, Koester KA, Cohen SE, Buchbinder S, Ladzekpo D, Matheson T, et al. Sexual behavior, risk compensation, and HIV prevention strategies among participants in the San Francisco PrEP demonstration project: a qualitative analysis of counseling notes. AIDS Behav. 2016;20(7):1461–9.

    Article  PubMed Central  Google Scholar 

  29. Grov C, Whitfield THF, Rendina HJ, Ventuneac A, Parsons JT. Willingness to take PrEP and potential for risk compensation among highly sexually active gay and bisexual men. AIDS Behav. 2015;19(12):2234–44.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Gafos M, Horne R, Nutland W, Bell G, Rae C, Wayal S, et al. The context of sexual risk behaviour among men who have sex with men seeking PrEP, and the impact of PrEP on sexual behaviour. AIDS Behav. 2019;23(7):1708–20.

    Article  PubMed  Google Scholar 

  31. Hoff CC, Chakravarty D, Bircher AE, Campbell CK, Grisham K, Neilands TB, et al. Attitudes towards PrEP and anticipated condom use among concordant HIV-negative and HIV-discordant male couples. AIDS Patient Care STDS. 2015;29(7):408–17.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Quinn K, Dickson-Gomez J, Zarwell M, Pearson B, Lewis M. “A gay man and a doctor are just like, a recipe for destruction”: how racism and homonegativity in healthcare settings influence PrEP uptake among young black MSM. AIDS Behav. 2019;23(7):1951–63.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Olansky E, Mansergh G, Pitts N, Mimiaga MJ, Denson DJ, Landers S, et al. PrEP awareness in the context of HIV/AIDS conspiracy beliefs among Black/African American and Hispanic/Latino MSM in three urban US cities. J Homosex. 2020;67(6):833–43.

    Article  PubMed  Google Scholar 

  34. Ojikutu BO, Amutah-Onukagha N, Mahoney TF, Tibbitt C, Dale SD, Mayer KH, et al. HIV-related mistrust (or HIV conspiracy theories) and willingness to use PrEP among black women in the United States. AIDS Behav. 2020;24:2927.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Eaton LA, Driffin DD, Kegler C, Smith H, Conway-Washington C, White D, et al. The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men. Am J Public Health [Internet]. 2015;105(2):e75-82.

    Article  Google Scholar 

  36. Quinn K, Bowleg L, Dickson-Gomez J. “The fear of being Black plus the fear of being gay”: the effects of intersectional stigma on PrEP use among young Black gay, bisexual, and other men who have sex with men. Soc Sci Med [Internet]. 2019;232:86–93. https://doi.org/10.1016/j.socscimed.2019.04.042.

    Article  Google Scholar 

  37. Halkitis P, Kapadia F, Ompad D. Incidence of HIV infection in young gay, bisexual, and other YMSM: the P18 Cohort Study. J Acquir Immune Defic Syndr. 2015;69(4):466.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Halkitis PN, Moeller RW, Siconolfi DE, Storholm ED, Solomon TM, Bub KL. Measurement model exploring a syndemic in emerging adult gay and bisexual men. AIDS Behav. 2013;17(2):662–73.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Halkitis PN, Kapadia F, Bub KL, Barton S, Moreira AD, Stults CB. A longitudinal investigation of syndemic conditions among young gay, bisexual, and other MSM: the P18 Cohort Study. AIDS Behav. 2015;19(6):970–80.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Bogart LM, Thorburn S. Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans? JAIDS J Acquir Immune Defic Syndr. 2005;38(2):213–8.

    Article  PubMed  Google Scholar 

  41. Thompson HS, Valdimarsdottir HB, Winkel G, Jandorf L, Redd W. The Group-Based Medical Mistrust Scale: psychometric properties and association with breast cancer screening. Prev Med (Baltim). 2004;38(2):209–18.

    Article  Google Scholar 

  42. Anderson LA, Dedrick RF. Development of the Trust in Physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychol Rep. 1990;67(3):1091–100.

    CAS  PubMed  Google Scholar 

  43. LaVeist TA, Isaac LA, Williams KP. Mistrust of health care organizations is associated with underutilization of health services. Health Serv Res. 2009;44(6):2093–105.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Heal. 1999;14(1):1–24.

    Article  Google Scholar 

  45. Rael CT, Martinez M, Giguere R, Bockting W, MacCrate C, Mellman W, et al. Barriers and facilitators to oral PrEP use among transgender women in New York City. AIDS Behav. 2018;22(11):3627–36.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Koechlin FM, Fonner VA, Dalglish SL, O’Reilly KR, Baggaley R, Grant RM, et al. Values and preferences on the use of oral pre-exposure prophylaxis (PrEP) for HIV prevention among multiple populations: a systematic review of the literature. AIDS Behav. 2017;21(5):1325–35.

    Article  PubMed  Google Scholar 

  47. Franks J, Hirsch-Moverman Y, Loquere AS, Amico KR, Grant RM, Dye BJ, et al. Sex, PrEP, and stigma: experiences with HIV pre-exposure prophylaxis among New York City MSM participating in the HPTN 067/ADAPT Study. AIDS Behav. 2018;22(4):1139–49.

    Article  PubMed  Google Scholar 

  48. John SA, Whitfield THF, Rendina HJ, Parsons JT, Grov C. Will gay and bisexual men taking oral pre-exposure prophylaxis (PrEP) switch to long-acting injectable PrEP should it become available? AIDS Behav. 2018;22(4):1184–9.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Freeborn K, Portillo CJ. Does pre-exposure prophylaxis for HIV prevention in men who have sex with men change risk behaviour? A systematic review. J Clin Nurs. 2018;27(17–18):3254–65.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Morgan E, Dyar C, Newcomb ME, Richard TD, Mustanski B. PrEP use and sexually transmitted infections are not associated longitudinally in a cohort study of young men who have sex with men and transgender women in Chicago. AIDS Behav. 2019;24:1334.

    Article  Google Scholar 

  51. Stenger MR, Baral S, Stahlman S, Wohlfeiler D, Barton JE, Peterman T. As through a glass, darkly: the future of sexually transmissible infections among gay, bisexual and other men who have sex with men. Sex Health. 2017;14(1):18–27.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Scott HM, Klausner JD. Sexually transmitted infections and pre-exposure prophylaxis: challenges and opportunities among men who have sex with men in the US. AIDS Res Ther. 2016;13(1):5.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Traeger MW, Cornelisse VJ, Asselin J, Price B, Roth NJ, Willcox J, et al. Association of HIV preexposure prophylaxis with incidence of sexually transmitted infections among individuals at high risk of HIV infection. JAMA. 2019;321(14):1380–90.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Walker D, Friderici J, Skiest D. Primary care providers have limited knowledge about STI screening and HIV PrEP in men who have sex with men. Open Forum Infect Dis. 2017;4:S667.

    Article  PubMed Central  Google Scholar 

  55. Hightow-Weidman LB, Magnus M, Beauchamp G, Hurt CB, Shoptaw S, Emel L, et al. Incidence and correlates of sexually transmitted infections among black men who have sex with men participating in the HIV prevention trials network 073 preexposure prophylaxis study. Clin Infect Dis. 2019;69(9):1597–604.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Calabrese SK, Krakower DS, Mayer KH. Integrating HIV preexposure prophylaxis (PrEP) into routine preventive health care to avoid exacerbating disparities. Am J Public Health. 2017;107(12):1883–9.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Pleuhs B, Quinn KG, Walsh JL, Petroll AE, John SA. Health care provider barriers to HIV pre-exposure prophylaxis in the United States: a systematic review. AIDS Patient Care STDS. 2020;34(3):111–23.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Carter MR, Aaron E, Nassau T, Brady KA. Knowledge, attitudes, and PrEP prescribing practices of health care providers in Philadelphia, PA. J Prim Care Community Heal. 2019;10:215013271987852.

    Article  Google Scholar 

  59. Tellalian D, Maznavi K, Bredeek UF, Hardy WD. Pre-exposure prophylaxis (PrEP) for HIV infection: results of a survey of HIV healthcare providers evaluating their knowledge, attitudes, and prescribing practices. AIDS Patient Care STDS. 2013;27(10):553–9.

    Article  PubMed  Google Scholar 

  60. Petroll AE, Walsh JL, Owczarzak JL, McAuliffe TL, Bogart LM, Kelly JA. PrEP awareness, familiarity, comfort, and prescribing experience among US primary care providers and HIV specialists. AIDS Behav. 2017;21(5):1256–67.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Ojile N, Sweet D, Kallail KJ. A preliminary study of the attitudes and barriers of family physicians to prescribing HIV preexposure prophylaxis. Kansas J Med. 2017;10(2):40.

    Article  Google Scholar 

  62. Meanley S, Gale A, Harmell C, Jadwin-Cakmak L, Pingel E, Bauermeister JA. The role of provider interactions on comprehensive sexual healthcare among young men who have sex with men. AIDS Educ Prev. 2015;27(1):15–26.

    Article  PubMed  Google Scholar 

  63. Nieto O, Brooks RA, Landrian A, Cabral A, Fehrenbacher AE. PrEP discontinuation among Latino/a and Black MSM and transgender women: a need for PrEP support services. PLoS One [Internet]. 2020;15(11):1–13. https://doi.org/10.1371/journal.pone.0241340.

    Article  CAS  Google Scholar 

  64. Garcia M, Harris AL. PrEP awareness and decision-making for Latino MSM in San Antonio, Texas. PLoS One. 2017;12(9):e0184014.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  65. Brooks RA, Landovitz RJ, Regan R, Lee S-J, Allen VC Jr. Perceptions of and intentions to adopt HIV pre-exposure prophylaxis among black men who have sex with men in Los Angeles. Int J STD AIDS. 2015;26(14):1040–8.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Jaiswal J, LoSchiavo C, Perlman DC. Disinformation, misinformation and inequality-driven mistrust in the time of COVID-19: lessons unlearned from AIDS denialism. AIDS Behav. 2020;24:2776.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Biello KB, Mimiaga MJ, Santostefano CM, Novak DS, Mayer KH. MSM at highest risk for HIV acquisition express greatest interest and preference for injectable antiretroviral PrEP compared to daily, oral medication. AIDS Behav. 2018;22(4):1158–64.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Cohen J. Long-acting injectable drug prevents HIV infections [Internet]. https://www.sciencemag.org/news/2020/05/long-acting-injectable-drug-prevents-hiv-infections. Accessed 27 May 2020

  69. Calabrese SK. Understanding, contextualizing, and addressing PrEP stigma to enhance PrEP implementation. Curr HIV/AIDS Rep. 2020;17(6):579–88.

    Article  PubMed  Google Scholar 

  70. Meanley S, Connochie D, Choi SK, Bonett S, Flores DD, Bauermeister JA. Assessing the role of gay community attachment, stigma, and PrEP stereotypes on young men who have sex with men’s PrEP uptake. AIDS Behav [Internet]. 2020. https://doi.org/10.1007/s10461-020-03106-7.

    Article  Google Scholar 

  71. Elsesser SA, Oldenburg CE, Biello KB, Mimiaga MJ, Safren SA, Egan JE, et al. Seasons of risk: anticipated behavior on vacation and interest in episodic antiretroviral pre-exposure prophylaxis (PrEP) among a large national sample of US men who have sex with men (MSM). AIDS Behav. 2016;20(7):1400–7.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Wilson EC, Turner CM, Arayasirikul S, Lightfoot M, Scheer S, Raymond HF, et al. Disparities in the PrEP continuum for trans women compared to MSM in San Francisco, California: results from population-based cross-sectional behavioural surveillance studies. J Int AIDS Soc. 2020. https://doi.org/10.1002/jia2.25539.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Sevelius JM, Keatley JA, Calma N, Arnold E. ‘I am not a man’: trans-specific barriers and facilitators to PrEP acceptability among transgender women. Glob Public Health. 2016;11(7–8):1060–75.

    Article  PubMed  Google Scholar 

  74. Conniff J, Evensen A. Preexposure prophylaxis (PrEP) for HIV prevention: the primary care perspective. J Am Board Fam Med. 2016;29(1):143–51.

    Article  PubMed  Google Scholar 

  75. Card KG, Hawkins BW, Mortazavi L, Gregory A, Ng KH, Lachowsky NJ. Stigma, the media, and pre-exposure prophylaxis for HIV prevention: observations for enhancing knowledge translation and resisting stigma in the Canadian context. AIDS Behav. 2019;23(7):1877–87.

    Article  PubMed  Google Scholar 

  76. Chávez PRG, Wesolowski LG, Peters PJ, Johnson CH, Nasrullah M, Oraka E, et al. How well are US primary care providers assessing whether their male patients have male sex partners? Prev Med (Baltim). 2018;107:75–80.

    Article  Google Scholar 

  77. Fuzzell L, Fedesco HN, Alexander SC, Fortenberry JD, Shields CG. “I just think that doctors need to ask more questions”: sexual minority and majority adolescents’ experiences talking about sexuality with healthcare providers. Patient Educ Couns. 2016;99(9):1467–72.

    Article  PubMed  Google Scholar 

  78. Halkitis PN, Jaiswal J, Griffin-Tomas M, Krause KD, D’Avanzo P, Kapadia F. Beliefs about the end of AIDS, concerns about PrEP functionality, and perceptions of HIV risk as drivers of PrEP use in urban sexual minority men: the P18 cohort study. AIDS Behav. 2018;22(11):3705–17.

    Article  PubMed  Google Scholar 

  79. Zhang HL, Rhea SK, Hurt CB, Mobley VL, Swygard H, Seña AC, et al. HIV pre-exposure prophylaxis implementation at local health departments: a statewide assessment of activities and barriers. J Acquir Immune Defic Syndr. 2018;77(1):72.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Goparaju L, Praschan NC, Warren-Jeanpiere L, Experton LS, Young MA, Kassaye S. Stigma, partners, providers and costs: potential barriers to PrEP uptake among US women. J AIDS Clin Res. 2017. https://doi.org/10.4172/2155-6113.1000730.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Ojikutu BO, Bogart LM, Higgins-Biddle M, Dale SK, Allen W, Dominique T, et al. Facilitators and barriers to pre-exposure prophylaxis (PrEP) use among black individuals in the United States: results from the National Survey on HIV in the Black Community (NSHBC). AIDS Behav. 2018;22(11):3576–87.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Marcus JL, Snowden JM. Words matter: putting an end to “unsafe” and “risky” sex. Sex Transm Dis. 2020;47(1):1.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Goddu AP, O’Conor KJ, Lanzkron S, Saheed MO, Saha S, Peek ME, et al. Do words matter? Stigmatizing language and the transmission of bias in the medical record. J Gen Intern Med. 2018;33(5):685–91.

    Article  Google Scholar 

  84. Brooks RA, Landrian A, Nieto O, Fehrenbacher A. Experiences of anticipated and enacted pre-exposure prophylaxis (PrEP) stigma among Latino MSM in Los Angeles. AIDS Behav. 2019;23(7):1964–73.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Brooks RA, Nieto O, Landrian A, Donohoe TJ. Persistent stigmatizing and negative perceptions of pre-exposure prophylaxis (PrEP) users: implications for PrEP adoption among Latino men who have sex with men. AIDS Care. 2019;31(4):427–35.

    Article  PubMed  Google Scholar 

  86. Ellorin E, Blumenthal J, Jain S, Sun X, Corado K, Dube M, et al. Frame me if you must: PrEP framing and the impact on adherence to HIV pre-exposure prophylaxis. Open Forum Infect Dis. 2017;4:439.

    Article  Google Scholar 

  87. Marcus JL, Katz KA, Krakower DS, Calabrese SK. Risk compensation and clinical decision making—the case of HIV preexposure prophylaxis. N Engl J Med. 2019;380(6):510.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Philbin MM, Parker CM, Parker RG, Wilson PA, Garcia J, Hirsch JS. Gendered social institutions and preventive healthcare seeking for black men who have sex with men: the promise of biomedical HIV prevention. Arch Sex Behav. 2018;47(7):2091–100.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Himmelstein MS, Sanchez DT. Masculinity impediments: internalized masculinity contributes to healthcare avoidance in men and women. J Health Psychol. 2016;21(7):1283–92.

    Article  PubMed  Google Scholar 

  90. Jaiswal J, LoSchiavo C, Maiolatesi A, Kapadia F, Halkitis PN. Misinformation, gendered perceptions, and low healthcare provider communication around HPV and the HPV vaccine among young sexual minority men in New York City: the P18 cohort study. J Community Health. 2020;45:702.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Griffith DM, Gilbert KL, Bruce MA, Thorpe RJ. Masculinity in men’s health: barrier or portal to healthcare? In: Men’s health in primary care. Cham: Springer; 2016. p. 19–31.

    Chapter  Google Scholar 

  92. Hammack PL, Toolis EE, Wilson BDM, Clark RC, Frost DM. Making meaning of the impact of pre-exposure prophylaxis (PrEP) on public health and sexual culture: narratives of three generations of gay and bisexual men. Arch Sex Behav [Internet]. 2019;48(4):1041–58. https://doi.org/10.1007/s10508-019-1417-6.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Griffin-Tomas M, Cahill S, Kapadia F, Halkitis PN. Access to health services among young adult gay men in New York City. Am J Mens Health. 2019;13(1):1557988318818683.

    Article  PubMed  Google Scholar 

  94. Jaiswal J, Singer SN, Siegel K, Lekas HM. HIV-related ‘conspiracy beliefs’: lived experiences of racism and socio-economic exclusion among people living with HIV in New York City. Cult Health Sex. 2019;21(4):373–86.

    Article  PubMed  Google Scholar 

Download references

Funding

The Health-Related Beliefs Sub-Study was funded by NIMH through the HIV Research Education Institute for Diverse Scholars (REIDS) at Yale University (25MH087217). Dr. Jaiswal was supported by BST NIDA T32DA007233. The P18 Cohort Study was funded by the National Institute of Drug Abuse (R01DA025537; 2R01DA025537). Dr. Halkitis and Caleb LoSchiavo are supported by NJ ACTS (UL1TR003017).

Author information

Authors and Affiliations

Authors

Contributions

Each author contributed to the preparation (data analysis, write-up, revisions) of this manuscript.

Corresponding author

Correspondence to J. Jaiswal.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical Approval

The first author’s institutional IRB approved the protocol for this study.

Consent to Participate

All participants provided verbal and written consent to participate.

Consent for Publication

We give consent for this manuscript to be published.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices

Appendix 1

HIV Conspiracy Beliefs

  1. 1.

    A lot of information about AIDS is being held back from the public.

  2. 2.

    HIV is a manmade virus.

  3. 3.

    There is a cure for AIDS, but it is being withheld from the poor.

  4. 4.

    The government is telling the truth about HIV.

  5. 5.

    HIV is a form of genocide against racial and ethnic minority people.

  6. 6.

    HIV was created by the government to control racial and ethnic minority people.

  7. 7.

    The medicine used to treat HIV causes people to get AIDS.

  8. 8.

    The medicine that doctors prescribe to treat HIV is poison.

  9. 9.

    People who take the new medicines for HIV are human guinea pigs for the government.

  10. 10.

    The government is deceiving people about the origins of HIV.

  11. 11.

    The pharmaceutical industry is deceiving people about the origins of HIV.

  12. 12.

    The government is deceiving people about treatment for HIV.

  13. 13.

    The pharmaceutical industry is deceiving people about treatment for HIV.

  14. 14.

    The government and pharmaceutical industry are working together to deceive people about treatment for HIV.

  15. 15.

    The government wants to keep people sick because they make a lot of money from ART.

  16. 16.

    The pharmaceutical industry wants to keep people sick because they make a lot of money from ART.

  17. 17.

    The cure for HIV is being withheld so more money can be made off of HIV medication.

  18. 18.

    Rich people have access to better HIV medication.

  19. 19.

    Rich people have access to the cure for HIV.

  20. 20.

    Pharmaceutical companies developed PrEP to make more profits.

  21. 21.

    HIV was developed by the government to target drug users.

  22. 22.

    HIV was developed by the government to target sexual and gender minority populations.

  23. 23.

    HIV was developed by the government to target Black/African American groups.

  24. 24.

    HIV was developed by the government to target Asian groups.

  25. 25.

    HIV was developed by the government to target Native American groups.

  26. 26.

    HIV was developed by the government to target Latino/a groups.

  27. 27.

    HIV was developed by the government to target White groups.

Group-Based Medical Mistrust Scale (GBMMS)—Racial/Ethnic Group

  1. 1.

    Doctors and health care workers sometimes hide information from my racial/ethnic group.

  2. 2.

    Doctors have the best interests of people of my racial/ethnic group in mind

  3. 3.

    People of my racial/ethnic group should not confide in doctors and health care workers because it will be used against them.

  4. 4.

    People of my racial/ethnic group should be suspicious of information from doctors and health care workers.

  5. 5.

    People of my racial/ethnic group cannot trust doctors and health care workers.

  6. 6.

    People of my racial/ethnic group should be suspicious of modern medications.

  7. 7.

    Doctors and health care workers treat people of my racial/ethnic group like ‘‘guinea pigs.’’

  8. 8.

    People of my racial/ethnic group receive the same medical care from doctors and health care workers as people from other groups.

  9. 9.

    Doctors and health care workers do not take the medical complaints of people of my racial/ethnic group seriously.

  10. 10.

    People of my racial/ethnic group are treated the same as people of other groups by doctors and health care workers.

  11. 11.

    In most hospitals, people of different racial/ethnic groups receive the same kind of care.

  12. 12.

    I have personally been treated poorly or unfairly by doctors or health care workers because of my racial/ethnic group.

Group-Based Medical Mistrust Scale (GBMMS)—Sexual/Gender Minority Group

  1. 1.

    Doctors and health care workers sometimes hide information from my sexual/gender minority group.

  2. 2.

    Doctors have the best interests of people of my sexual/gender minority group in mind

  3. 3.

    People of my sexual/gender minority group should not confide in doctors and health care workers because it will be used against them.

  4. 4.

    People of my sexual/gender minority group should be suspicious of information from doctors and health care workers.

  5. 5.

    People of my sexual/gender minority group cannot trust doctors and health care workers.

  6. 6.

    People of my v should be suspicious of modern medications.

  7. 7.

    Doctors and health care workers treat people of my sexual/gender minority group like ‘‘guinea pigs.’’

  8. 8.

    People of my sexual/gender minority group receive the same medical care from doctors and health care workers as people from other groups.

  9. 9.

    Doctors and health care workers do not take the medical complaints of people of my sexual/gender minority group seriously.

  10. 10.

    People of my sexual/gender minority group are treated the same as people of other groups by doctors and health care workers.

  11. 11.

    In most hospitals, people of different sexual/gender minority groups receive the same kind of care.

  12. 12.

    I have personally been treated poorly or unfairly by doctors or health care workers because of my sexual/gender minority group.

Beliefs about Medicines Questionnaire

  1. 1.

    Newer medications are more effective than older ones.

  2. 2.

    Most medications are addictive.

  3. 3.

    People who take medications should stop their treatment for a while every now and again.

  4. 4.

    Medications only work if they are taken regularly.

  5. 5.

    Medications do more harm than good.

  6. 6.

    Medications are not natural remedies.

  7. 7.

    All medications are poisons.

  8. 8.

    It is better to do without medications.

  9. 9.

    Natural remedies are safer than medications.

  10. 10.

    Stronger medications are more dangerous than weaker medications.

  11. 11.

    Medications are a necessary evil.

  12. 12.

    Doctors place too much trust in medications.

  13. 13.

    If doctors had more time with patients, they would prescribe fewer medications

  14. 14.

    There is a big different between a medication and a drug.

  15. 15.

    The medication you get is more important than the doctor you see.

  16. 16.

    Doctors use too many medications.

  17. 17.

    Most medications are safe.

  18. 18.

    People are prescribed too many medications these days.

  19. 19.

    People shouldn't take a medication until they really need it.

Trust in Physician Scale (TIPS)

  1. 1.

    I doubt that my doctor really cares about me as a person.

  2. 2.

    My doctor is usually considerate of my needs and puts them first

  3. 3.

    I trust my doctor so much that i always try to follow his/her advice

  4. 4.

    If my doctor tells me something is so, then it must be true.

  5. 5.

    I sometimes distrust my doc- tor’s opinion and would like a second one.

  6. 6.

    I trust my doctor’s judgment about my medical care.

  7. 7.

    I feel my doctor does not do everything he/she should for my medical care.

  8. 8.

    I trust my doctor to put my medical needs above all other considerations when treating my medical problems

  9. 9.

    My doctor is a real expert in taking care of medical problems like mine.

  10. 10.

    I trust my doctor to tell me if a mistake was made about my treatment.

  11. 11.

    I sometimes worry that my doctor may not keep the information we discuss totally private.

Trust in Healthcare System

  1. 1.

    How much do you trust the healthcare system?

  2. 2.

    How willing are you to put your life in the hands of the healthcare system?

  3. 3.

    How confident are you in the healthcare system’s ability to care for your health?

  4. 4.

    How much do you trust the healthcare system to give you the best possible care?

Medical Mistrust Index (MMI)

  1. 1.

    Patients have sometimes been deceived or misled by health care organizations.

  2. 2.

    When health care organizations make mistakes, they usually cover it up.

  3. 3.

    Health care organizations have sometimes done harmful experiments on patients without their knowledge.

  4. 4.

    Health care organizations don’t always keep your information totally private.

  5. 5.

    Mistakes are common in health care organizations.

  6. 6.

    I trust that health care organizations will tell me if a mistake is made about my treatment.

  7. 7.

    The patient’s medical needs come before other considerations at health care organizations.

  8. 8.

    Health care organizations are more concerned about making money than taking care of people.

  9. 9.

    Health care organizations put the patient’s health first.

  10. 10.

    Patients should always follow the advice given to them at health care organizations.

  11. 11.

    I typically get a second opinion when I am told something about my health.

  12. 12.

    They know what they are doing at health care organizations.

  13. 13.

    I trust that health care organizations keep up with the latest medical information.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jaiswal, J., LoSchiavo, C., Meanley, S. et al. Correlates of PrEP Uptake Among Young Sexual Minority Men and Transgender Women in New York City: The Need to Reframe “Risk” Messaging and Normalize Preventative Health. AIDS Behav 25, 3057–3073 (2021). https://doi.org/10.1007/s10461-021-03254-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-021-03254-4

Keywords

Navigation