AIDS and Behavior

, Volume 18, Issue 2, pp 226–240

The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access

  • Sarah K. Calabrese
  • Valerie A. Earnshaw
  • Kristen Underhill
  • Nathan B. Hansen
  • John F. Dovidio
Original Paper


Antiretroviral pre-exposure prophylaxis (PrEP) has received increasing recognition as a viable prescription-based intervention for people at risk for HIV acquisition. However, little is known about racial biases affecting healthcare providers’ willingness to prescribe PrEP. This investigation sought to explore medical students’ stereotypes about sexual risk compensation among Black versus White men who have sex with men seeking PrEP, and the impact of such stereotypes on willingness to prescribe PrEP. An online survey presented participants (n = 102) with a clinical vignette of a PrEP-seeking, HIV-negative man with an HIV-positive male partner. Patient race was systematically manipulated. Participants reported predictions about patient sexual risk compensation, willingness to prescribe PrEP, and other clinical judgments. Bootstrapping analyses revealed that the Black patient was rated as more likely than the White patient to engage in increased unprotected sex if prescribed PrEP, which, in turn, was associated with reduced willingness to prescribe PrEP to the patient.


Race/ethnicity Men who have sex with men (MSM) Pre-exposure prophylaxis (PrEP) Risk compensation Healthcare provider 


La profilaxis pre-exposición con antirretrovirales (PrEP) ha recibido cada vez más reconocimiento como intervención viable a base de receta para personas en riesgo de contraer el VIH. Sin embargo, se conoce poco acerca de los prejuicios raciales que afectan a la disposición de los proveedores de salud a prescribir PrEP. Esta investigación buscó explorar los estereotipos de los estudiantes de medicina sobre la compensación del riesgo sexual entre hombres negros versus hombres blancos que tienen sexo con hombres que solicitan la PrEP, y el impacto de esos estereotipos sobre la voluntad de prescribir PrEP. Una encuesta por Internet presentó a los participantes (n = 102) una viñeta clínica de una petición de PrEP; un hombre sin VIH con una pareja masculina seropositiva. La raza del paciente fue manipulada sistemáticamente. Los participantes informaron de las predicciones de la compensación del riesgo del paciente, de la voluntad de prescribir PrEP, y de otros juicios clínicos. Análisis de muestreo revelaron que el paciente negro fue clasificado como más propenso que el paciente blanco a participar en el aumento de relaciones sexuales sin protección si la PrEPera prescrita, lo cual, a su vez, fue asociado con una reducción de la disposición para prescribir PrEP al paciente.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Sarah K. Calabrese
    • 1
  • Valerie A. Earnshaw
    • 1
  • Kristen Underhill
    • 1
    • 2
  • Nathan B. Hansen
    • 1
    • 3
  • John F. Dovidio
    • 4
  1. 1.Center for Interdisciplinary Research on AIDSYale UniversityNew HavenUSA
  2. 2.Yale Law SchoolYale UniversityNew HavenUSA
  3. 3.College of Public HealthUniversity of GeorgiaAthensUSA
  4. 4.Department of PsychologyYale UniversityNew HavenUSA

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