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Geographic and Individual Associations with PrEP Stigma: Results from the RADAR Cohort of Diverse Young Men Who have Sex with Men and Transgender Women

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Abstract

Increasing the uptake of pre-exposure prophylaxis (PrEP) to prevent HIV acquisition among at-risk populations, such as young men who have sex with men (YMSM), is of vital importance to slowing the HIV epidemic. Stigma and negative injunctive norms, such as the so called “Truvada Whore” phenomenon, hamper this effort. We examined the prevalence and types of PrEP stigma and injunctive norm beliefs among YMSM and transgender women and associated individual and geospatial factors. A newly created measure of PrEP Stigma and Positive Attitudes was administered to 620 participants in an ongoing longitudinal cohort study. Results indicated lower stigma among White, compared to Black and Latino participants, and among participants not identifying as male. Prior knowledge about PrEP was associated with lower stigma and higher positive attitudes. PrEP stigma had significant geospatial clustering and hotspots were identified in neighborhoods with high HIV incidence and concentration of racial minorities, whereas coldspots were identified in areas with high HIV incidence and low LGBT stigma. These results provide important information about PrEP attitudes and how PrEP stigma differs between individuals and across communities.

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Acknowledgements

We would like to thank participants of RADAR. RADAR is funded by the National Institute on Drug Abuse of the National Institutes of Health under Award Number U01 01DA036939. Third Coast Center for AIDS Research is supported by the National Institutes of Health under Award Number P30 AI117943. The content of this article is solely the responsibility of the authors and does not necessarily reflect the view of the National Institutes of Health.

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Authors and Affiliations

  1. Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave Suite 1400, Chicago, IL, 60611, USA

    Brian Mustanski, Daniel T. Ryan, Gregory Phillips II & Michael E. Newcomb

  2. Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Brian Mustanski, Daniel T. Ryan, Gregory Phillips II & Michael E. Newcomb

  3. Third Coast Center for AIDS Research, Northwestern University, Chicago, IL, USA

    Brian Mustanski & Christina Hayford

  4. Center for Prevention Implementation Methodology, Northwestern University, Chicago, IL, USA

    Brian Mustanski & Justin D. Smith

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  1. Brian Mustanski
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  2. Daniel T. Ryan
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  3. Christina Hayford
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  4. Gregory Phillips II
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  5. Michael E. Newcomb
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Correspondence to Brian Mustanski.

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Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Northwestern University Institutional Review Board and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

Appendix A: Measure of PrEP Stigma and Positive Attitudes

Appendix A: Measure of PrEP Stigma and Positive Attitudes

Before today, have you ever heard of pre-exposure prophylaxis (PrEP)?

  • No (go to prompt A)

  • Yes (go to prompt B)

Prompt A

Pre-exposure prophylaxis (PrEP) is a way for people who do not have HIV, but who are at substantiated risk of getting it to prevent HIV infection by taking a pill every day. When someone is exposed to HIV through sex or injection drug use, the pill can work to keep the virus from establishing a permanent infection. When taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92%. PrEP is much less effective if it is not taken consistently. People have different opinions about PrEP. Now that you have learned about PrEP, please indicate how much you agree with the following statement.

Prompt B

People have different opinions about PrEP. Please indicate how much you agree with the following statements.

  1. 1.

    I think people should take PrEP. (PA)

  2. 2.

    People who are on PrEP sleep around. (PS)

  3. 3.

    People who are on PrEP are irresponsible. (PS)

  4. 4.

    Having sex with someone on PrEP is risky. (PS)

  5. 5.

    People who are on PrEP are making a smart decision to protect their health. (PA)

  6. 6.

    I would not trust someone who told me they were on PrEP. (PS)

  7. 7.

    People who are on PrEP can’t control their sex drive. (PS)

  8. 8.

    People who are on PrEP use it as an excuse to have sex without a condom. (PS)

  9. 9.

    Many people on PrEP lie about whether or not they take it every day. (PS)

  10. 10.

    People who are on PrEP are responsible. (PA)

Response Options: 1 = Strongly disagree, 2 = Disagree, 3 = Neither agree nor disagree, 4 = Agree, 5 = Strongly agree

*PS = PrEP stigma subscale, PA = Positive attitudes subscale

Author Recommendations

For future use of this measure, the authors recommend displaying Prompt A to all respondents regardless of their level of PrEP awareness at time of data collection and scoring the measure by calculating the mean value for each subscale.

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Mustanski, B., Ryan, D.T., Hayford, C. et al. Geographic and Individual Associations with PrEP Stigma: Results from the RADAR Cohort of Diverse Young Men Who have Sex with Men and Transgender Women. AIDS Behav 22, 3044–3056 (2018). https://doi.org/10.1007/s10461-018-2159-5

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