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Understanding Influences on Intention to Use Pre-exposure Prophylaxis (PrEP) Among African American Young Adults

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Abstract

Pre-exposure prophylaxis (PrEP), a potent medication for HIV prevention, shows promise for reducing HIV disparities. However, PrEP is not equitably utilized by all races and ethnicities in the USA. Its uptake is especially low among African Americans, who are disproportionately impacted by HIV. Understanding factors influencing low PrEP uptake among diverse priority groups of African American young adults beyond gender and sexual minority groups (e.g., cisgender heterosexual people) may increase PrEP uptake. Data were from the Afya project, a study examining the use of PrEP for HIV prevention among multiple priority groups of African American young adults at heightened HIV risk, using Theory of Reasoned Action/Theory of Planned Behavior (TRA/TPB) as a theoretical framework. Eleven focus groups (N = 63) were conducted in Louisville, Kentucky from June to November 2018 with African American young adult priority groups (18–29 years old): men who have sex with men, transgender women, and cisgender heterosexual men and women demonstrating heightened sexual risk. Data were analyzed using constructivist grounded theory techniques. PrEP awareness, knowledge, perceived HIV risk and perceived need for PrEP (behavioral beliefs) and adherence beliefs (control beliefs), opinions of others (subjective norms), and confidence in ability to adhere to PrEP (perceived behavior controls) influenced acceptability of PrEP (participants’ attitudes) and, in turn, influenced intention to use PrEP either negatively or positively. Thus, understanding factors that create reticence to PrEP use provides useful insight for tailoring outreach interventions towards African American young adults to improve PrEP uptake.

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Source: Theory of Planned Behavior [29]

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Acknowledgements

The authors would like to acknowledge and appreciate the contributions of the following: research assistants (Kelsey Burton, Toya Northington, Chelsea Burton, Nana Ama Bullock, Frances Mican, Isabel Rozema, and Gaberiel Jones), study participants, and the community advisory board. The authors also acknowledge and thank Jewish Heritage Fund for Excellence for funding this project.

Funding

Funding for this study was provided by a grant from the Jewish Heritage Fund for Excellence.

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Authors and Affiliations

  1. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Suur D. Ayangeakaa

  2. Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA

    Jelani Kerr & Ryan Combs

  3. Kent School of Social Work, University of Louisville, Louisville, KY, USA

    Lesley Harris & Emma Sterrett-Hong

  4. Department of Human Services, Bowling Green State University, Bowling Green, OH, USA

    Jeanelle Sears

  5. Parker Owens Research Group, Dallas, TX, USA

    Kimberly Parker

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  1. Suur D. Ayangeakaa
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  4. Lesley Harris
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  5. Jeanelle Sears
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  7. Emma Sterrett-Hong
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Contributions

Suur Ayangeakaa led the secondary analysis for this paper and drafted the first version of the article. Jelani Kerr was the lead investigator of the primary study, provided advise, and contributed to content on behavioral theories. Ryan Combs was a coinvestigator on the primary study, advised and assisted Suur Ayangeakaa during initial coding stage, and editing of manuscript. Lesley Harris was a coinvestigator on the primary study, conceived the idea to use constructivist grounded theory analytic techniques, provided mentorship to Suur Ayangeakaa, and contributed to manuscript content and editing. Jeanelle Sears assisted with secondary coding, intercoder reliability, and editing of manuscript. Kimberly Parker provided mentorship to Suur Ayangeakaa and contributed to initial edits of the article. Emma Sterret-Hong contributed to editing the manuscript and suggested new content to strengthen the arguments and conclusions in the article.

Corresponding author

Correspondence to Suur D. Ayangeakaa.

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Ethics Approval

The University of Louisville Institutional Review Board approved this study.

Ethical Standards and Informed Consent

This study was conducted in accordance with the ethical standards of human subjects research as laid down by the Helsinki Declaration of 1975, as revised in 2000. All participants in the study provided informed consent to be included in the study.

Conflict of Interest

Suur Ayangeakaa has received consulting fees from Gilead. Jelani Kerr has received consulting fees from Gilead. Kimberly Parker has received consulting fees and grant funding from Gilead.

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Ayangeakaa, S.D., Kerr, J., Combs, R. et al. Understanding Influences on Intention to Use Pre-exposure Prophylaxis (PrEP) Among African American Young Adults. J. Racial and Ethnic Health Disparities 10, 899–910 (2023). https://doi.org/10.1007/s40615-022-01278-7

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  • DOI: https://doi.org/10.1007/s40615-022-01278-7

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