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Barriers and Facilitators to Acceptability and Uptake of Pre-Exposure Prophylaxis (PrEP) Among Black Women in the United States: a Systematic Review

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Abstract

Objectives

Pre-exposure prophylaxis (PrEP) provides a salient avenue to address the profound HIV-related health disparities that Black women in the United States face. This systematic review assessed the acceptability of PrEP within this population, and identified barriers and facilitators to its acceptability and uptake.

Methods

We searched PubMed and Web of Science using 48 search input combinations; this produced 338 unique articles, 16 of which were included in the review.

Results

We analyzed the results using the socio-ecological model (SEM). Findings indicate generally positive attitudes towards PrEP among Black women, although acceptance levels vary widely. Individual-level barriers included inadequate levels of PrEP awareness and knowledge, low HIV-risk perception, and concerns about adherence and side effects; interpersonal-level barriers were the influence of sexual and romantic partners and stigma from family; societal-level barriers included lack of PrEP marketing towards Black women, medical mistrust, cost, and structural violence. The main facilitators at the individual-level were PrEP education and information; at the interpersonal-level, distrust in sexual partners, healthcare provider encouragement, and social support; at the societal-level, PrEP accessibility, and affordability. No community-level barriers or facilitators were identified.

Conclusions

PrEP should be marketed directly to Black women in the US and campaigns should highlight this medication’s effectiveness, accessibility, affordability, and safety. Medical mistrust must also be addressed to enable Black women to feel comfortable following their healthcare providers’ advice regarding PrEP.

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Authors and Affiliations

  1. Department of International Development, Community and Environment, Clark University, Worcester, MA, USA

    Frerik Smit

  2. Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia

    Frerik Smit

  3. Health Studies Program, Center for Interdisciplinary Studies, College of the Holy Cross, 1 College St, Worcester, MA, 01602, USA

    Tsitsi B. Masvawure

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Contributions

Conceptualization: Frerik Smit and Tsitsi Masvawure, methodology: Frerik Smit and Tsitsi Masvawure, formal analysis and investigation: Frerik Smit, writing—original draft preparation: Frerik Smit, writing—review and editing: Frerik Smit and Tsitsi Masvawure, supervision: Tsitsi Masvawure.

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Correspondence to Frerik Smit.

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Smit, F., Masvawure, T.B. Barriers and Facilitators to Acceptability and Uptake of Pre-Exposure Prophylaxis (PrEP) Among Black Women in the United States: a Systematic Review. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01729-9

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