Abstract
Pre-exposure prophylaxis (PrEP) is a biomedical HIV prevention strategy with potential to reduce racial HIV disparities. However, African-Americans have not received the benefits of PrEP to the same extent as other groups. The theory of planned behavior (TPB) was employed to explain intentions to use PrEP among a sample of African-Americans (age 18–29) in Louisville, Kentucky. Data were derived from the Afya Project, a study examining PrEP-focused HIV prevention for African-American young adults. The sample was developed through respondent-driven sampling and participants (N = 181) completed audio computer-assisted self-interviews assessing demographics and TPB variables. Analysis of variance was used to examine relationships between demographics and PrEP intentions. Linear regressions determined associations between control beliefs, attitudes, norms, and PrEP use intentions. Confidence in using PrEP (p ≤ .0001), perceived HIV risk (p ≤ 0.05), perceived likelihood of acquiring HIV (p ≤ 0.05), and positive norms around PrEP (p ≤ 0.05) were significantly associated with PrEP use intentions. Findings can inform interventions to advance PrEP as a HIV prevention option for African-American populations at higher risk of contracting HIV.
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References
Ajzen, I. (1985). From intentions to actions a theory of planned behavior. In J. Kuhl & J. Beckmann (Eds.), Action control. New York: Springer.
Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Prentice-Hall.
Albarracin, D., Johnson, B. T., Fishbein, M., & Muellerleile, P. A. (2001). Theories of reasoned action and planned behavior as models of condom use: A meta-analysis. Psychological Bulletin, 127(1), 142–161. https://doi.org/10.1037/0033-2909.127.1.142
Artiga, S., & Orgera, K. (2020). Key facts on health and health care by race and ethnicity. Retrieved from https://www.kff.org/report-section/key-facts-on-health-and-health-care-by-race-and-ethnicity-coverage-access-to-and-use-of-care/
Brooks, R. A., Allen, V. C., Jr., Regan, R., Mutchler, M. G., Cervantes-Tadeo, R., & Lee, S. J. (2018). HIV/AIDS conspiracy beliefs and intention to adopt preexposure prophylaxis among black men who have sex with men in Los Angeles. International Journal of STD and AIDS, 29(4), 375–381. https://doi.org/10.1177/0956462417727691
Brooks, R. A., Landovitz, R. J., Regan, R., Lee, S. J., & Allen, V. C. (2015). Perceptions of and intentions to adopt HIV pre-exposure prophylaxis among black men who have sex with men in Los Angeles. International Journal of STD and AIDS, 26(14), 1040–1048. https://doi.org/10.1177/0956462415570159
Cahill, S., Taylor, S. W., Elsesser, S. A., Mena, L., Hickson, D., & Mayer, K. H. (2017). 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, 29(11), 1351–1358. https://doi.org/10.1080/09540121.2017.1300633
Centers for Disease Control and Prevention. (2016). 2016 Conference on Retroviruses and Opportunistic Infections. Retrieved from https://www.cdc.gov/nchhstp/newsroom/2016/croi-2016.html
Centers for Disease Control and Prevention. (2017). HIV Surveillance-Adolescents and Young Adults. Retrieved from https://www.cdc.gov/hiv/pdf/library/slidesets/cdc-hiv-surveillance-adolescents-young-adults-2017.pdf
Centers for Disease Control and Prevention. (2020a). HIV Surveillance Report, 2018 (Updated). Retrieved from http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html
Centers for Disease Control and Prevention. (2020b). NCHHSTP Atlas Plus. Retrieved from https://www.cdc.gov/nchhstp/atlas/index.htm
Dehlin, J. M., Stillwagon, R., Pickett, J., Keene, L., & Schneider, J. A. (2019). #PrEP4Love: An evaluation of a sex-positive HIV prevention campaign. JMIR Public Health and Surveillance, 5(2), e12822. https://doi.org/10.2196/12822
Dowse, R., Barford, K., & Browne, S. H. (2014). Simple, illustrated medicines information improves ARV knowledge and patient self-efficacy in limited literacy South African HIV patients. AIDS Care, 26(11), 1400–1406. https://doi.org/10.1080/09540121.2014.931559
Eaton, L. A., Driffin, D. D., Smith, H., Conway-Washington, C., White, D., & Cherry, C. (2014). Psychosocial factors related to willingness to use pre-exposure prophylaxis for HIV prevention among Black men who have sex with men attending a community event. Sexual Health, 11(3), 244–251. https://doi.org/10.1071/SH14022
Erlen, J. A., Cha, E. S., Kim, K. H., Caruthers, D., & Sereika, S. M. (2010). The HIV Medication Taking Self-efficacy Scale: Psychometric evaluation. Journal of Advanced Nursing, 66(11), 2560–2572.
Fletcher, F. E., Fisher, C., Buchberg, M. K., Floyd, B., Hotton, A., Ehioba, A., & Donenberg, G. (2018). “Where did this [PrEP] come from?” African American mother/daughter perceptions related to adolescent preexposure prophylaxis (PrEP) utilization and clinical trial participation. Journal of Empirical Research on Human Research Ethics, 13(2), 173–184. https://doi.org/10.1177/1556264618755919
Golub, S. A. (2018). PrEP stigma: Implicit and explicit drivers of disparity. Current HIV/AIDS Reports, 15(2), 190–197. https://doi.org/10.1007/s11904-018-0385-0
Golub, S. A., Fikslin, R. A., Goldberg, M. H., Pena, S. M., & Radix, A. (2019). Predictors of PrEP uptake among patients with equivalent access. AIDS and Behavior, 23(7), 1917–1924. https://doi.org/10.1007/s10461-018-2376-y
Golub, S. A., Gamarel, K. E., Rendina, H. J., Surace, A., & Lelutiu-Weinberger, C. L. (2013). From efficacy to effectiveness: Facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care and STDS, 27(4), 248–254. https://doi.org/10.1089/apc.2012.0419
Hannaford, A., Lipshie-Williams, M., Starrels, J. L., Arnsten, J. H., Rizzuto, J., Cohen, P., Jacobs, D., & Patel, V. V. (2018). The use of online posts to identify barriers to and facilitators of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men: A comparison to a systematic review of the peer-reviewed literature. AIDS and Behavior, 22(4), 1080–1095. https://doi.org/10.1007/s10461-017-2011-3
Heckathorn, D. D. (1997). Respondent-driven sampling: A new approach to the study of hidden populations. Social Problems, 44(2), 174–199.
Heckathorn, D. D. (2002). Respondent-driven sampling II: Deriving valid population estimates from chain-referral samples of hidden populations. Social Problems, 49(1), 11–34.
HIV.gov. (2020). PrEP Basics. Retrieved from https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis
Huang, Y. A., Zhu, W., Smith, D. K., Harris, N., & Hoover, K. W. (2018). HIV Preexposure prophylaxis, by race and ethnicity-United States, 2014–2016. Morbidity and Mortality Weekly Report, 67(41), 1147–1150. https://doi.org/10.15585/mmwr.mm6741a3
Johnson, A. K., Fletcher, F. E., Ott, E., Wishart, M., Friedman, E. E., Terlikowski, J., & Haider, S. (2020). Awareness and intent to use pre-exposure prophylaxis (PrEP) among African American women in a family planning clinic. Journal of Racial and Ethnic Health Disparities, 7(3), 550–554. https://doi.org/10.1007/s40615-019-00683-9
Kaiser Family Foundation. (2020). Health coverage & uninsured. Retrieved from https://www.kff.org/state-category/health-coverage-uninsured/nonelderly-uninsured/
Keene, L. C., Dehlin, J. M., Pickett, J., Berringer, K. R., Little, I., Tsang, A., Bouris, A. M., & Schneider, J. A. (2021). #PrEP4Love: Success and stigma following release of the first sex-positive PrEP public health campaign. Culture, Health and Sexuality, 23, 397–413. https://doi.org/10.1080/13691058.2020.1715482
Kelly, J. A., Amirkhanian, Y. A., Walsh, J. L., Brown, K. D., Quinn, K. G., Petroll, A. E., Pearson, B. M., Noel Rosado, A., & Ertl, T. (2020). Social network intervention to increase pre-exposure prophylaxis (PrEP) awareness, interest, and use among African American men who have sex with men. AIDS Care, 32(sup2), 40–46. https://doi.org/10.1080/09540121.2020.1739207
Kerr, J., Ayangeakaa, S., Combs, R., Harris, L., Sears, J., Northington, T., Burton, K., Sterrett-Hong, E., Parker, K., & Krigger, K. (2021). Community-informed development of a campaign to increase HIV pre-exposure prophylaxis (PrEP) awareness among African American young adults. Journal of Racial and Ethnic Health Disparities, 8(4), 901–911. https://doi.org/10.1007/s40615-020-00848-x
Koechlin, F. M., Fonner, V. A., Dalglish, S. L., O’Reilly, K. R., Baggaley, R., Grant, R. M., Rodolph, M., Hodges-Mameletzis, I., & Kennedy, C. E. (2017). 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 and Behavior, 21(5), 1325–1335. https://doi.org/10.1007/s10461-016-1627-z
Mera, R., Hawkins, T., Bush, S., Nguyen, C., Anderson, J., Asubonteng, J., Das, M., & McCallister, S. (2019). The impact of pre-exposure prophylaxis (PrEP) on HIV incidence in 19 fast track cities (FTCs) in the US between 2012–2017. Paper presented at the Fast-Track Cities 2019, London, England. https://www.iapac.org/files/2019/10/FTC2019-OA17880.pdf
Montano, D. E., & Kasprzyk, D. (2015). Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior: Theory, research, and practice (pp. 95–124). San Francisco: Jossey-Bass.
Morrison-Beedy, D., Carey, M. P., & Tu, X. (2006). Accuracy of audio computer-assisted self-interviewing (ACASI) and self-administered questionnaires for the assessment of sexual behavior. AIDS and Behavior, 10(5), 541–552. https://doi.org/10.1007/s10461-006-9081-y
Phillips, G., Raman, A. B., Felt, D., McCuskey, D. J., Hayford, C. S., Pickett, J., Lindeman, Peter T., & Mustanski, B. (2020). PrEP4Love: The role of messaging and prevention advocacy in PrEP attitudes, perceptions, and uptake among YMSM and transgender women. Journal of Acquired Immune Deficiency Syndrome, 83(5), 450–456. https://doi.org/10.1097/QAI.0000000000002297
Qu, D., Zhong, X., Lai, M., Dai, J., Liang, H., & Huang, A. (2019). Influencing factors of pre-exposure prophylaxis self-efficacy among men who have sex with men. American Journal of Men’s Health, 13(2), 1557988319847088. https://doi.org/10.1177/1557988319847088
Roth, A., Felsher, M., Tran, N., Bellamy, S., Martinez-Donate, A., Krakower, D., & Szep, Z. (2019). Drawing from the theory of planned behaviour to examine pre-exposure prophylaxis uptake intentions among heterosexuals in high HIV prevalence neighbourhoods in Philadelphia, Pennsylvania, USA: An observational study. Sexual Health, 16(3), 218–224. https://doi.org/10.1071/SH18081
Russ, S., Zhang, C., & Liu, Y. (2021). Pre-exposure prophylaxis care continuum, barriers, and facilitators among black men who have sex with men in the United States: A systematic review and meta-analysis. AIDS and Behavior, 25, 2278–2288. https://doi.org/10.1007/s10461-020-03156-x
Schnarrs, P. W., Gordon, D., Martin-Valenzuela, R., Sunil, T., Delgado, A. J., Glidden, D., Parsons, J. T., & McAdams, J. (2018). Perceived social norms about oral PrEP use: Differences between African-American, Latino and white gay, bisexual and other men who have sex with men in Texas. AIDS and Behavior, 22(11), 3588–3602. https://doi.org/10.1007/s10461-018-2076-7
Smith, D. K., Toledo, L., Smith, D. J., Adams, M. A., & Rothenberg, R. (2012). Attitudes and program preferences of African-American urban young adults about pre-exposure prophylaxis (PrEP). AIDS Education and Prevention, 24(5), 408–421. https://doi.org/10.1521/aeap.2012.24.5.408
Smith, D. K., Van Handel, M., & Grey, J. (2018). Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group and race/ethnicity, United States, 2015. Annals of Epidemiology, 28(12), 850–857. https://doi.org/10.1016/j.annepidem.2018.05.003
Teitelman, A. M., Chittamuru, D., Koblin, B. A., Davis, A., Brawner, B. M., Fiore, D., & Tieu, H. V. (2020). Beliefs associated with intention to use PrEP among cisgender U.S. women at elevated HIV risk. Archives of Sexual Behavior, 49(6), 2213–2221. https://doi.org/10.1007/s10508-020-01681-3
Tekeste, M., Hull, S., Dovidio, J. F., Safon, C. B., Blackstock, O., Taggart, T., Kershaw, T. S., Kaplan, C., Caldwell, A., Lane, S. B., & Calabrese, S. K. (2019). Differences in medical mistrust between black and white women: Implications for patient-provider communication about PrEP. AIDS and Behavior, 23(7), 1737–1748. https://doi.org/10.1007/s10461-018-2283-2
Wolf, M. S., Davis, T. C., Osborn, C. Y., Skripkauskas, S., Bennett, C. L., & Makoul, G. (2007). Literacy, self-efficacy, and HIV medication adherence. Patient Education and Counseling, 65(2), 253–260.
Yi, S., Tuot, S., Mwai, G. W., Ngin, C., Chhim, K., Pal, K., Igbinedion, E., Holland, P., Choub, S. C., & Mburu, G. (2017). Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle-income countries: a systematic review and meta-analysis. Journal of the International AIDS Society, 20(1), 21580. https://doi.org/10.7448/IAS.20.1.21580
Acknowledgement
This study was funded by the Jewish Heritage Fund for Excellence and the National Institute of Mental Health/National Institutes of Health (K01 MH119942-02). The research team would like to acknowledge the contributions of the study coordinator (Toya Northington), research assistants (Kelsey Burton, Chelsea Burton, Frances Mican, and Isabel Rozema), study participants, and the community advisory board.
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J. Kerr has received consulting fees from Gilead. K. Parker has received consulting fees and grant funding from Gilead.
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This study was approved by the Institutional Review Board of the University of Louisville.
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Kerr, J., Combs, R., Ayangeakaa, S. et al. Examining Factors that Impact Intentions to Use Pre-Exposure Prophylaxis Among African-American Young Adults. Arch Sex Behav 50, 2933–2941 (2021). https://doi.org/10.1007/s10508-021-01974-1
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DOI: https://doi.org/10.1007/s10508-021-01974-1