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Accessing Pre-exposure Prophylaxis (PrEP): Perceptions of Current and Potential PrEP Users in Birmingham, Alabama

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Abstract

Limited studies to date assess barriers to and facilitators of PrEP uptake and utilization using a patient-centered access to care framework, among diverse socio-demographic groups, or in the U.S. Deep South, an area with disproportionate HIV burden. We examine perceptions of PrEP access in qualitative interviews with 44 current and potential PrEP users in Birmingham, Alabama. Participants were 32 years old on average, 66% Black, 66% gay or lesbian, 70% male, and 66% single. Perceived barriers to PrEP access included: lack of PrEP awareness and advertisement; sexuality-related stigma; time and resource constraints; and concerns about the adequacy and technical quality of PrEP services. Perceived facilitators to PrEP access were: PrEP-related information gathering and sharing; increased dialogue and visibility around PrEP; social, programmatic, and clinical support; and, lastly, self-preservation; personal motivation; and treatment self-efficacy. Results point to opportunities to address complex barriers to equitable PrEP access using multilevel and multimodal solutions.

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Acknowledgements

This research was supported by the University of Alabama at Birmingham Center for AIDS Research, a National Institutes of Health (NIH) funded program (P30 AI027767) that was made possible by the following institutes: NIAID, NCI, NICHD, NHLBI, NIDA, NIA, NIDDK, NIGMS, and OAR. K.B.C. and W.S.R. received support through an institutional training grant from the Agency for Healthcare Research and Quality (AHRQ T32HS013852). K.L.S. received support through institutional training grants from the National Institute of Drug Abuse (5T32DA037801 and R25DA037190). Investigator support (B.T.) for this study was also provided by the National Institute of Mental Health (R01MH104114). The contents of this publication are the sole responsibility of the authors and do not represent the official views of the NIH or AHRQ.

Funding

This study was funded by the University of Alabama at Birmingham Center for AIDS Research.

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Authors and Affiliations

  1. Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, GCR 538, Atlanta, GA, 30322, USA

    Whitney S. Rice

  2. Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA

    Kristi L. Stringer

  3. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Maira Sohail

  4. Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Kaylee B. Crockett & Janet M. Turan

  5. Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA

    Ghislaine C. Atkins & Bulent Turan

  6. Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Kachina Kudroff

  7. Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA

    D. Scott Batey

  8. Magic City Wellness Center, Birmingham, AL, USA

    Joshua Hicks

  9. Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Michael J. Mugavero

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  1. Whitney S. Rice
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Correspondence to Whitney S. Rice.

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Conflict of interest

Whitney S. Rice declares that she has no conflict of interest. Kristi L. Stringer declares that she has no conflict of interest. Maira Sohail declares that she has no conflict of interest. Kaylee B. Crockett declares that she has no conflict of interest. Ghislaine C. Atkins declares that she has no conflict of interest. Kachina Kudroff declares that she has no conflict of interest. D. Scott Batey declares that he has no conflict of interest. Joshua Hicks declares that he has no conflict of interest. Janet M. Turan declares that she has no conflict of interest. Michael J. Mugavero has served as a scientific advisor for Gilead Sciences, Inc. Bulent Turan declares that he has no conflict of interest.

Ethical Approval

The human subjects protocol for this study was approved by the Institutional Review Boards at the University of Alabama at Birmingham and at Emory University.

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

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Rice, W.S., Stringer, K.L., Sohail, M. et al. Accessing Pre-exposure Prophylaxis (PrEP): Perceptions of Current and Potential PrEP Users in Birmingham, Alabama. AIDS Behav 23, 2966–2979 (2019). https://doi.org/10.1007/s10461-019-02591-9

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