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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

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Abstract

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.

Resumen

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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Acknowledgments

Sarah K. Calabrese and Valerie A. Earnshaw were supported by Award Number T32MH020031 from the National Institute of Mental Health. Research reported in this publication was supported by the National Institute of Mental Health under Award Number P30MH062294. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. The authors wish to thank the restaurant owners who generously donated gift cards in support of this study. In addition, they are grateful to Dr. Jaimie Meyer for contributing her medical expertise in developing the clinical vignette, Dr. Nancy Angoff for facilitating recruitment, and the medical students for their participation.

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  1. Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510, USA

    Sarah K. Calabrese, Valerie A. Earnshaw, Kristen Underhill & Nathan B. Hansen

  2. Yale Law School, Yale University, New Haven, CT, USA

    Kristen Underhill

  3. College of Public Health, University of Georgia, Athens, GA, USA

    Nathan B. Hansen

  4. Department of Psychology, Yale University, New Haven, CT, USA

    John F. Dovidio

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  1. Sarah K. Calabrese
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Correspondence to Sarah K. Calabrese.

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Calabrese, S.K., Earnshaw, V.A., Underhill, K. et al. 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. AIDS Behav 18, 226–240 (2014). https://doi.org/10.1007/s10461-013-0675-x

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