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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References
Centers for Disease Control and Prevention. HIV surveillance report, 2019. U.S. Department of Health & Human Services; 2021. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2018-updated-vol-32.pdf. Accessed 18 Sep 2022
Conley C, Johnson R, Bond K, Brem S, Salas J, Randolph S. US Black cisgender women and pre-exposure prophylaxis for human immunodeficiency virus prevention: a scoping review. Womens Health. 2022;18. https://doi.org/10.1177/17455057221103098.
Sales JM, Steiner RJ, Brown JL, Swartzendruber A, Patel AS, Sheth AN. PrEP eligibility and interest among clinic- and community-recruited young Black women in Atlanta, Georgia, USA. Curr HIV Res. 2018;16(3):250–5. https://doi.org/10.2174/1570162X16666180731143756.
Willie T, Kershaw T, Campbell JC, Alexander KA. Intimate partner violence and PrEP acceptability among low-income, young Black women: exploring the mediating role of reproductive coercion. AIDS Behav. 2017;21:2261–9. https://doi.org/10.1007/s10461-017-1767-9.
Office of Minority Health. HIV/AIDS and African Americans. U.S. Department of Health & Human Services; 2021. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=21. Accessed 1 Nov 2022
Centers for Disease Control and Prevention. Leading causes of death – females – non-Hispanic Black – United States – 2018. U.S. Department of Health & Human Services; 2022. https://www.cdc.gov/women/lcod/2018/nonhispanic-Black/index.htm. Accessed 18 Sep 2022
Johnson AK, Fletcher FE, Ott E, Wishart M, Friedman EE, Terlikowski J, Haider S. Awareness and intent to use pre-exposure prophylaxis (PrEP) among African American women in a family planning clinic. J Racial Ethn Health Disparities. 2020;7:550–4. https://doi.org/10.1007/s40615-019-00683-9.
Willie TC, Knight D, Baral SD, Chan PA, Kershaw T, Mayer KH, Stockman JK, Adimora AA, Monger M, Mena LA, Philllips KA, Nunn A. Where's the “everyday Black woman”? An intersectional qualitative analysis of Black women’s decision-making regarding HIV pre-exposure prophylaxis (PrEP) in Mississippi. BMC Public Health. 2022;22(1):1604. https://doi.org/10.1186/s12889-022-13999-9.
Hill BS, Patel VV, Haughton LJ, Blackstock OJ. Leveraging social media to explore Black women’s perspectives on HIV pre-exposure prophylaxis. J Assoc of Nurses in AIDS Care. 2018;29(1):107. https://doi.org/10.1016/j.jana.2017.06.010.
Craddock JB, Mangum LC, Aidoo-Frimpong G, Whitfield DL. The associations of HIV pre-exposure prophylaxis interest and sexual risk behaviors among young Black women. AIDS Patient Care STDS. 2021;35(7):263–70. https://doi.org/10.1089/apc.2020.0259.
Nydegger LA, Dickson-Gomez J, Ko TK. 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. 2021a;25:582–91. https://doi.org/10.1007/s10461-020-03015-9.
Washington Health Institute. What is PrEP and how does it work? Washington Health Institute.; 2021. https://dc-whi.org/what-is-prep-and-how-does-it-work/. Accessed 18 Nov 2022
Nydegger LA, Dickson-Gomez J, Ko TK. Structural and syndemic barriers to PrEP adoption among Black women at high risk for HIV: a qualitative exploration. Cult Health Sex. 2021;23(5):659–73. https://doi.org/10.1080/13691058.2020.1720297.
Huang YA, Zhu W, Smith DK, Harris N, Hoover KW. HIV preexposure prophylaxis, by race and ethnicity - United States, 2014-2016. Morb Mortal Wkly Rep. 2018;67(41):1147. https://doi.org/10.15585/mmwr.mm6741a3.
Hill LM, Lightfoot AF, Riggins L, Golin CE. Awareness of and attitudes toward pre-exposure prophylaxis among African American women living in low-income neighborhoods in a southeastern city. AIDS Care. 2021;33(2):239–43. https://doi.org/10.1080/09540121.2020.1769834.
Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. Br Méd J. 2021;372:n160. https://doi.org/10.1136/bmj.n160.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906. https://doi.org/10.1136/bmj.n71.
Bond KT, Gunn A, Williams P, Leonard NR. Using an intersectional framework to understand the challenges of adopting pre-exposure prophylaxis (PrEP) among young adult Black women. Sex Res Soc Policy. 2022:1–4. https://doi.org/10.1007/s13178-021-00533-6.
D'Angelo AB, Davis Ewart LN, Koken J, Bimbi D, Brown JT, Grov C. Barriers and facilitators to pre-exposure prophylaxis uptake among Black women: a qualitative analysis guided by a socioecological model. J Assoc Nurses AIDS Care. 2021;32(4):481–94. https://doi.org/10.1097/JNC.0000000000000241.
Tesfay FH, Ziersch A, Mwanri L, Javanparast S. Experience of nutritional counselling in a nutritional programme in HIV care in the Tigray region of Ethiopia using the socio-ecological model. J Health Popul Nutr. 2021;40:34. https://doi.org/10.1186/s41043-021-00256-9.
Baral S, Logie CH, Grosso A, Wirtz AL, Beyrer C. Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health. 2013;13(1):1–8. https://doi.org/10.1186/1471-2458-13-482.
Centers for Disease Control and Prevention. The social-ecological model: a framework for prevention. United States Department of Health & Human Services; 2022. https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html. Accessed 18 Nov 2022
Dahlberg LL, Krug EG. Violence: a global public health problem. In: Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, editors. World report on violence and health. Geneva: World Health Organization; 2002. p. 1–21.
Sales JM, Sheth AN. Associations among perceived HIV risk, behavioral risk and interest in PrEP among Black women in the southern US. AIDS Behav. 2019;23:1871–6. https://doi.org/10.1007/s10461-018-2333-9.
Ojikutu BO, Amutah-Onukagha N, Mahoney TF, Tibbitt C, Dale SD, Mayer KH, Bogart LM. HIV-related mistrust (or HIV conspiracy theories) and willingness to use PrEP among Black women in the United States. AIDS Behav. 2020;24:2927–34. https://doi.org/10.1007/s10461-020-02843-z.
Craddock JB, Franke ND, Kingori C. Associations of social network- and individual-level factors with HIV testing, condom use, and interest in PrEP among young Black women. Arch Sex Behav. 2022;51(5):2473–83. https://doi.org/10.1007/s10508-022-02306-7.
Mangum LC, Craddock JB, Whitfield DL. Associations in preventive sexual health service utilization and pre-exposure prophylaxis (PrEP) interest among young Black women in the United States, 2018. AIDS Care. 2022;34(3):324–30. https://doi.org/10.1080/09540121.2021.1925213.
Pratt MC, Jeffcoat S, Hill SV, Gill E, Elopre L, Simpson T, Lanzi R, Matthews LT. We feel like everybody’s going to judge us: Black adolescent girls’ and young women’s perspectives on barriers to and opportunities for improving sexual health care, including PrEP, in the southern U.S. J Int Assoc Provid AIDS Care. 2022;21. https://doi.org/10.1177/23259582221107327.
Apicha Community Health Center. New York City’s campaign promoting PrEP for women. Apicha Commun Health Center. 2018. https://blog.apicha.org/new-york-citys-campaign-promoting-prep-for-women. Accessed 3 Nov 2022
Baugher AR, Trujillo L, Kanny D, Freeman JQ, Hickey T, Sionean C, Respress E, Chapin-Bardales J, Marcus R, Finlayson T, Wejnert C, National HIV Behavioral Surveillance Study Group. Racial, ethnic, and gender disparities in awareness of preexposure prophylaxis among HIV-negative heterosexually active adults at increased risk for HIV infection - 23 urban areas, United States, 2019. Morb Mortal Wkly Rep. 2021;70(47):1635. https://doi.org/10.15585/mmwr.mm7047a3.
HIV.gov. CDC’s new #sheswell initiative aims to increase PrEP awareness among women and their healthcare providers. U.S. Department of Health & Human Services; 2021. https://www.hiv.gov/blog/cdc-s-new-sheswell-initiative-aims-increase-prep-awareness-among-women-and-their-healthcare. Accessed 3 Nov 2022
Gilbert L, Goddard-Eckrich D, Chang M, Hunt T, Wu E, Johnson K, Richards S, Goodwin S, Tibbetts R, Metsch LR, El-Bassel N. Effectiveness of a culturally tailored HIV and sexually transmitted infection prevention intervention for Black women in community supervision programs: a randomized clinical trial. JAMA Netw Open. 2021;4(4):e215226. https://doi.org/10.1001/jamanetworkopen.2021.5226.
Black Aids Institute. Welcome to the Black women and PrEP Toolkit. Black Aids Institute.; 2023. https://Blackaids.org/campaign/Black-women-and-prep/. Accessed 26 Jun 2023
Chandler R, Hull S, Ross H, Guillaume D, Paul S, Dera N, Hernandez N. The pre-exposure prophylaxis (PrEP) consciousness of Black college women and the perceived hesitancy of public health institutions to curtail HIV in Black women. BMC Public Health. 2020;20:1172. https://doi.org/10.1186/s12889-020-09248-6.
Frye V, Paige MQ, Gordon S, Matthews D, Musgrave G, Kornegay M, Greene E, Phelan JC, Koblin BA, Taylor-Akutagawa V. Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in New York city: the project CHHANGE model. Eval Program Plan. 2017;63:45–53. https://doi.org/10.1016/j.evalprogplan.2017.03.004.
Frye V, Paige MQ, Gordon S, Matthews D, Musgrave G, Greene E, Kornegay M, Farhat D, Smith PH, Usher D, Phelan JC, Koblin BA, Taylor-Akutagawa V. Impact of a community-level intervention on HIV stigma, homophobia and HIV testing in New York city: results from project CHHANGE. Stig Health. 2019;4(1):72. https://doi.org/10.1037/sah0000109.
Felsher M, Dutra K, Monseur B, Roth AM, Latkin C, Falade-Nwulia O. The influence of PrEP-related stigma and social support on PrEP-use disclosure among women who inject drugs and social network members. AIDS Behav. 2021;25(12):3922–32. https://doi.org/10.1007/s10461-021-03312-x.
Centers for Disease Control and Prevention. Sister to sister: an HIV risk reduction intervention. U.S. Department of Health & Human Services; 2020. https://www.cdc.gov/hiv/research/interventionresearch/rep/packages/sisters.html. Accessed 26 Jun 2023
Centers for Disease Control and Prevention. Sister to sister: take control of your health. U.S. Department of Health & Human Services; 2023. https://www.cdc.gov/hiv/effective-interventions/prevent/sister-to-sister/. Accessed 26 Jun 2023
Jemmott LS, Jemmott JB 3rd, O’Leary A. Effects on sexual risk behavior and STD rate of brief HIV/STD prevention interventions for African American women in primary care settings. Am J Public Health. 2007;97(6):1034–40. https://doi.org/10.2105/AJPH.2003.020271.
Millett G, Malebranche D, Mason B, Spikes P. Focusing “down low”: bisexual Black men, HIV risk and heterosexual transmission. J National Méd Assoc. 2005;97(7):52S–9S.
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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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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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DOI: https://doi.org/10.1007/s40615-023-01729-9