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A Longitudinal, Qualitative Exploration of Perceived HIV Risk, Healthcare Experiences, and Social Support as Facilitators and Barriers to PrEP Adoption Among Black Women

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Abstract

Black women contract HIV at much higher rates than White or Hispanic women. Pre-exposure prophylaxis (PrEP) is an underutilized prevention tool among this population. We sought to determine participants’ interest in PrEP and facilitators and barriers to PrEP adoption. This longitudinal, qualitative study included 30 Black women (Mage = 32.2) interviewed 4 times over 6 months. Most participants had never heard of PrEP and a majority expressed initial interest. Barriers to PrEP initiation included low perceived HIV risk, medical mistrust, provider experiences and knowledge, negative reactions from family and friends, low perceived efficacy to adherence, and transportation. This study demonstrated actual, rather than hypothetical, PrEP interest and attitudes among Black women, and the barriers that arose over time during the study. PrEP awareness needs to be promoted among Black women and medical providers. Future research should address individual risk perception, medical mistrust, increasing social support, and decreasing transportation barriers.

Resumen

Las mujeres negras contraen el VIH en tasas mucho más altas que las mujeres blancas o hispanas. La profilaxis de preexposición al VIH (PrEP) es una herramienta de prevención infrautilizada entre esta población. Buscamos determinar el interés de las participantes en la PrEP y los facilitadores y las barreras para la adopción de la PrEP. Este estudio longitudinal y cualitativo incluyó a 30 mujeres negras (Mage = 32,2) entrevistadas 4 veces durante 6 meses. La mayoría de las participantes nunca habían oído hablar de la PrEP y la mayoría expresó un interés inicial. Las barreras para el inicio de la PrEP incluyeron un bajo riesgo percibido de VIH, desconfianza médica, experiencias y conocimientos del proveedor, reacciones negativas de familiares y amigos, baja eficacia percibida para la adherencia, y transporte. Este estudio demostró intereses y actitudes reales, más que hipotéticos, sobre la PrEP entre las mujeres negras, y las barreras que surgieron con el tiempo durante el estudio. Se debe promover la concienciación sobre la PrEP entre las mujeres negras y los proveedores médicos. Las investigaciones futuras deben abordar la percepción del riesgo individual, la desconfianza médica, el aumento del apoyo social, y la disminución de las barreras del transporte.

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Acknowledgements

The authors gratefully acknowledge the participants who shared their stories. We also thank the project staff and students at the Medical College of Wisconsin, and Sarah Gojer, MPH and Sabrina Benitez at the University of Texas at Austin who dedicated their time to this research. This research was funded by the National Institute of Mental Health (P30 MH52776 and T32 0MH19985) and supported by grant P2CHD042849 awarded to the Population Research Center at The University of Texas by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

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Authors and Affiliations

  1. Department of Kinesiology and Health Education, University of Texas at Austin, 2109 San Jacinto Blvd., Ste. 718, Austin, TX, 78712, USA

    Liesl A. Nydegger

  2. Department of Epidemiology, Medical College of Wisconsin, Milwaukee, WI, USA

    Julia Dickson-Gomez

  3. Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA

    Thant Ko Ko

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  1. Liesl A. Nydegger
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Nydegger, L.A., Dickson-Gomez, J. & Ko Ko, T. A Longitudinal, Qualitative Exploration of Perceived HIV Risk, Healthcare Experiences, and Social Support as Facilitators and Barriers to PrEP Adoption Among Black Women. AIDS Behav 25, 582–591 (2021). https://doi.org/10.1007/s10461-020-03015-9

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