Skip to main content

Advertisement

SpringerLink
Log in

Understanding, Contextualizing, and Addressing PrEP Stigma to Enhance PrEP Implementation

  • Implementation Science (E Geng, Section Editor)
  • Published:
Current HIV/AIDS Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

HIV pre-exposure prophylaxis (PrEP) is a safe and effective preventive intervention that could play a central role in ending the HIV epidemic. However, low uptake in general, and among certain social groups in particular, underscores the need to identify and address barriers to PrEP use. PrEP stigma has emerged as a key factor interfering with PrEP interest, uptake, and continuation. The purpose of this article is to describe and contextualize PrEP stigma and to offer recommendations on how to address it in future PrEP implementation initiatives.

Recent Findings

PrEP users are commonly stereotyped as sexually irresponsible, promiscuous, and immoral. These stereotypes and associated prejudice manifest at multiple levels and discourage PrEP interest and uptake, disrupt PrEP adherence, and motivate PrEP discontinuation. Intersecting forms of stigma may influence the nature, magnitude, and impact of PrEP stigma across social groups and otherwise hinder PrEP use. Current PrEP implementation strategies that narrowly focus on risk and target stigmatized groups with disproportionately high HIV incidence have yielded limited success and are counterproductive to the extent that they perpetuate stigma. Implementation strategies involving more inclusive messaging and further integration of PrEP within healthcare may help to reduce PrEP stigma and mitigate its impact, ultimately increasing PrEP use.

Summary

PrEP stigma is a barrier to PrEP interest, uptake, and continuation that manifests at multiple levels. Understanding and addressing PrEP stigma requires consideration of its origins and intersections. Targeted, risk-focused implementation strategies perpetuate stigma and undermine use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. AVAC. PrEPWatch. 2020. https://www.prepwatch.org/in-practice/global-prep-tracker/. Accessed 15 Sept 2020.

  2. Harris NS, Johnson AS, Huang YA, Kern D, Fulton P, Smith DK, et al. Vital signs: status of human immunodeficiency virus testing, viral suppression, and HIV preexposure prophylaxis - United States, 2013-2018. Morb Mortal Wkly Rep. 2019;68(48):1117–23.

    Google Scholar 

  3. Haire BG. Preexposure prophylaxis-related stigma: strategies to improve uptake and adherence - a narrative review. HIV AIDS (Auckl). 2015;7:241–9.

    Google Scholar 

  4. • Herron PD. Current perspectives on the impact of pre-exposure prophylaxis stigma regarding men who have sex with men in the United States. HIV AIDS (Auckl). 2020;12:187–92 This review discusses the origins of PrEP stigma and future mitigation strategies.

    Google Scholar 

  5. •• Golub SA. PrEP stigma: implicit and explicit drivers of disparity. Curr HIV/AIDS Rep. 2018;15(2):190–7 This review describes several mechanisms via which PrEP stigma impedes scalability, thoroughly addresses the issue of risk compensation, and offers actionable recommendations for addressing stigma.

  6. •• Golub SA, Myers JE. Next-wave HIV pre-exposure prophylaxis implementation for gay and bisexual men. AIDS Patient Care STDS. 2019;33(6):253–61 This article illuminates how a risk-driven approach undermines PrEP implementation and emphasizes the importance of integrating PrEP with other health services.

  7. Goffman E. Stigma: notes on the management of a spoiled identity. New York, NY: Simon & Schuster, Inc.; 1963.

    Google Scholar 

  8. Major B, Dovidio JF, Link BG, Calabrese SK. Stigma and its implications for health: introduction and overview. In: Major B, Dovidio JF, Link BG, editors. The Oxford handbook of stigma, discrimination, and health. New York: Oxford University Press; 2018. p. 1–28.

    Google Scholar 

  9. Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol. 2001;27(1):363–5.

  10. Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160–77.

    PubMed  PubMed Central  Google Scholar 

  11. Hatzenbuehler ML, Link BG. Introduction to the special issue on structural stigma and health. Soc Sci Med. 2014;103:1–6.

    PubMed  Google Scholar 

  12. Bosco SC, Pawson M, Parsons JT, Starks TJ. Biomedical HIV prevention among gay male couples: a qualitative study of motivations and concerns. J Homosex [journal on the Internet]. 6 Dec 2019 [cited 15 Sep 2020]. https://doi.org/10.1080/00918369.2019.1696105.

  13. Golub SA, Gamarel KE, Surace A. Demographic differences in PrEP-related stereotypes: implications for implementation. AIDS Behav. 2017;21(5):1229–35.

    PubMed  PubMed Central  Google Scholar 

  14. Goparaju L, Praschan NC, Warren-Jeanpiere L, Experton LS, Young MA, Kassaye S. Stigma, partners, providers and costs: potential barriers to PrEP uptake among US women. J AIDS Clin Res. 2017;8(9):730.

    PubMed  PubMed Central  Google Scholar 

  15. Brooks RA, Landrian A, Nieto O, Fehrenbacher A. Experiences of anticipated and enacted pre-exposure prophylaxis (PrEP) stigma among Latino MSM in Los Angeles. AIDS Behav. 2019;23(7):1964–73.

  16. • Quinn K, Bowleg L, Dickson-Gomez J. “The fear of being Black plus the fear of being gay”: the effects of intersectional stigma on PrEP use among young Black gay, bisexual, and other men who have sex with men. Soc Sci Med. 2019;232:86–93. This article provides insights about stigma intersectionality in the context of PrEP.

  17. Spieldenner A. PrEP whores and HIV prevention: the queer communication of HIV pre-exposure prophylaxis (PrEP). J Homosex. 2016;63(12):1685–97.

    PubMed  Google Scholar 

  18. Duran D. Truvada whores? Huffington Post. 2012. https://www.huffpost.com/entry/truvada-whores_b_2113588. Accessed 15 Sept 2020.

  19. Golub SA, Lelutiu-Weinberger C, Surace A. Experimental investigation of implicit HIV and preexposure prophylaxis stigma: evidence for ancillary benefits of preexposure prophylaxis use. J Acquir Immune Defic Syndr. 2018;77(3):264–71.

    PubMed  Google Scholar 

  20. Martinez JE, Jonas KJ. Social judgments of sexual behavior and use of HIV pre-exposure prophylaxis. Soc Cogn. 2020;38(1):1–20.

    Google Scholar 

  21. Eaton LA, Kalichman SC, Price D, Finneran S, Allen A, Maksut J. Stigma and conspiracy beliefs related to pre-exposure prophylaxis (PrEP) and interest in using PrEP among Black and White men and transgender women who have sex with men. AIDS Behav. 2017;21(5):1236–46.

    PubMed  PubMed Central  Google Scholar 

  22. Bourne A, Cassolato M, Thuan Wei CK, Wang B, Pang J, Lim SH, et al. Willingness to use pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men (MSM) in Malaysia: findings from a qualitative study. J Int AIDS Soc. 2017;20(1):21899.

  23. Sun CJ, Anderson KM, Toevs K, Morrison D, Wells C, Nicolaidis C. “Little tablets of gold”: an examination of the psychological and social dimensions of PrEP among LGBTQ communities. AIDS Educ Prev. 2019;31(1):51–62.

  24. Pawson M, Grov C. ‘It’s just an excuse to slut around’: gay and bisexual mens' constructions of HIV pre-exposure prophylaxis (PrEP) as a social problem. Sociol Health Illn. 2018;40(8):1391–403.

    PubMed  Google Scholar 

  25. Franks J, Hirsch-Moverman Y, Loquere AS Jr, Amico KR, Grant RM, Dye BJ, et al. Sex, PrEP, and stigma: experiences with HIV pre-exposure prophylaxis among New York City MSM participating in the HPTN 067/ADAPT Study. AIDS Behav. 2018;22(4):1139–49.

  26. Brooks RA, Nieto O, Landrian A, Donohoe TJ. Persistent stigmatizing and negative perceptions of pre-exposure prophylaxis (PrEP) users: implications for PrEP adoption among Latino men who have sex with men. AIDS Care. 2019;31(4):427–35.

  27. Brooks RA, Nieto O, Landrian A, Fehrenbacher A, Cabral A. Experiences of pre-exposure prophylaxis (PrEP)-related stigma among Black MSM PrEP users in Los Angeles. J Urban Health [journal on the Internet]. 18 Jun 2019 [cited 15 Sep 2020]. https://doi.org/10.1007/s11524-019-00371-3.

  28. Patel VV, Santoro AF, Chaudhry J, Krasz AK, Golub SA, Mayer KH, et al. Primary care providers' role in HIV prevention with pre-exposure prophylaxis (PrEP): perspectives from young men of color who have sex with men. 11th International Conference on HIV Treatment and Prevention Adherence, Abstract 184. May 2016; Fort Lauderdale, FL.

  29. Dubov A, Galbo P Jr, Altice FL, Fraenkel L. Stigma and shame experiences by MSM who take PrEP for HIV prevention: a qualitative study. Am J Mens Health. 2018;12(6):1843–54.

    PubMed  PubMed Central  Google Scholar 

  30. Smith DK, Herbst JH, Rose CE. Estimating HIV protective effects of method adherence with combinations of preexposure prophylaxis and condom use among African American men who have sex with men. Sex Transm Dis. 2015;42(2):88–92.

    PubMed  Google Scholar 

  31. Anderson PL, Glidden DV, Liu A, Buchbinder S, Lama JR, Guanira JV, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med. 2012;4(151):151ra25.

    Google Scholar 

  32. Weeks J. The sexual citizen. Theory Cult Soc. 1998;15(3–4):35–52.

    Google Scholar 

  33. Calabrese SK, Underhill K. How stigma surrounding the use of HIV preexposure prophylaxis undermines prevention and pleasure: a call to destigmatize “Truvada whores”. Am J Public Health. 2015;105(10):1960–4.

    PubMed  PubMed Central  Google Scholar 

  34. Elopre L, McDavid C, Brown A, Shurbaji S, Mugavero MJ, Turan JM. Perceptions of HIV pre-exposure prophylaxis among young, Black men who have sex with men. AIDS Patient Care STDS. 2018;32(12):511–8.

  35. Calabrese SK, Dovidio JF, Tekeste M, Taggart T, Galvao RW, Safon CB, et al. HIV pre-exposure prophylaxis stigma as a multidimensional barrier to uptake among women who attend Planned Parenthood. J Acquir Immune Defic Syndr. 2018;79(1):46–53.

  36. Puppo C, Spire B, Morel S, Genin M, Beniguel L, Costagliola D, et al. How PrEP users constitute a community in the MSM population through their specific experience and management of stigmatization. The example of the French ANRS-PREVENIR study. AIDS Care. 2020;32(sup2):32–9.

    CAS  PubMed  Google Scholar 

  37. Arnold T, Brinkley-Rubinstein L, Chan PA, Perez-Brumer A, Bologna ES, Beauchamps L, et al. Social, structural, behavioral and clinical factors influencing retention in pre-exposure prophylaxis (PrEP) care in Mississippi. PLoS One. 2017;12(2):e0172354.

    PubMed  PubMed Central  Google Scholar 

  38. Pillay D, Stankevitz K, Lanham M, Ridgeway K, Murire M, Briedenhann E, et al. Factors influencing uptake, continuation, and discontinuation of oral PrEP among clients at sex worker and MSM facilities in South Africa. PLoS One. 2020;15(4):e0228620.

  39. Storholm ED, Volk JE, Marcus JL, Silverberg MJ, Satre DD. Risk perception, sexual behaviors, and PrEP adherence among substance-using men who have sex with men: a qualitative study. Prev Sci. 2017;18(6):737–47.

    PubMed  PubMed Central  Google Scholar 

  40. Calabrese SK, Magnus M, Mayer KH, Krakower DS, Eldahan AI, Gaston Hawkins LA, et al. “Support your client at the space that they’re in”: pre-exposure prophylaxis (PrEP) prescribers’ perspectives on PrEP-related risk compensation. AIDS Patient Care STDS. 2017;31(4):196–204.

  41. Mack N, Wong C, McKenna K, Lemons A, Odhiambo J, Agot K. Human resource challenges to integrating HIV pre-exposure prophylaxis (PrEP) into the public health system in Kenya: a qualitative study. Afr J Reprod Health. 2015;19(1):54–62.

    PubMed  Google Scholar 

  42. Owens C, Hubach RD, Williams D, Lester J, Reece M, Dodge B. Exploring the pre-exposure prophylaxis (PrEP) health care experiences among men who have sex with men (MSM) who live in rural areas of the Midwest. AIDS Educ Prev. 2020;32(1):51–66.

    PubMed  Google Scholar 

  43. Skolnik AA, Bokhour BG, Gifford AL, Wilson BM, Van Epps P. Roadblocks to PrEP: what medical records reveal about access to HIV pre-exposure prophylaxis. J Gen Intern Med. 2020;35(3):832–8.

    PubMed  Google Scholar 

  44. Hedrick AM, Carpentier FRD. How current and potential pre-exposure prophylaxis (PrEP) users experience, negotiate and manage stigma: disclosures and backstage processes in online discourse. Cult Health Sex [journal on the Internet]. 26 Jun 2020 [cited 15 Sep 2020]. https://doi.org/10.1080/13691058.2020.1752398.

  45. Calabrese SK, Earnshaw VA, Underhill K, Krakower DS, Magnus M, Hansen NB, et al. Prevention paradox: medical students are less inclined to prescribe HIV pre-exposure prophylaxis for patients in highest need. J Int AIDS Soc. 2018;21(6):e25147.

    PubMed  PubMed Central  Google Scholar 

  46. Schwartz J, Grimm J. PrEP on twitter: information, barriers, and stigma. Health Commun. 2017;32(4):509–16.

    PubMed  Google Scholar 

  47. Card KG, Hawkins BW, Mortazavi L, Gregory A, Ng KH, Lachowsky NJ. Stigma, the media, and pre-exposure prophylaxis for HIV prevention: observations for enhancing knowledge translation and resisting stigma in the Canadian context. AIDS Behav. 2019;23(7):1877–87.

  48. McLaughlin ML, Hou J, Meng J, Hu CW, An Z, Park M, et al. Propagation of information about preexposure prophylaxis (PrEP) for HIV prevention through Twitter. Health Commun. 2016;31(8):998–1007.

  49. Phillips G 2nd, Raman AB, Felt D, McCuskey DJ, Hayford CS, Pickett J, et al. PrEP4Love: the role of messaging and prevention advocacy in PrEP attitudes, perceptions, and uptake among YMSM and transgender women. J Acquir Immune Defic Syndr. 2020;83(5):450–6.

    PubMed  PubMed Central  Google Scholar 

  50. Keene LC, Dehlin JM, Pickett J, Berringer KR, Little I, Tsang A et al. #PrEP4Love: success and stigma following release of the first sex-positive PrEP public health campaign. Cult Health Sex [journal on the Internet]. 26 Mar 2020 [cited 15 Sep 2020]. https://doi.org/10.1080/13691058.2020.1752398.

  51. Quinn KG, Christenson E, Sawkin MT, Hacker E, Walsh JL. The unanticipated benefits of PrEP for young black gay, bisexual, and other men who have sex with men. AIDS Behav. 2020;24(5):1376–88.

    PubMed  PubMed Central  Google Scholar 

  52. Bazzi AR, Leech AA, Biancarelli DL, Sullivan M, Drainoni ML. Experiences using pre-exposure prophylaxis for safer conception among HIV serodiscordant heterosexual couples in the United States. AIDS Patient Care STDS. 2017;31(8):348–55.

  53. Hynie M, Lydon JE. Women's perceptions of female contraceptive behavior: experimental evidence of the sexual double standard. Psychol Women Q. 1995;19(4):563–81.

    CAS  PubMed  Google Scholar 

  54. Scales P. Males and morals: teenage contraceptive behavior amid the double standard. Fam Coord. 1977;26:211–22.

    Google Scholar 

  55. Biello KB, Oldenburg CE, Mitty JA, Closson EF, Mayer KH, Safren SA, et al. The “safe sex” conundrum: anticipated stigma from sexual partners as a barrier to PrEP use among substance using MSM engaging in transactional sex. AIDS Behav. 2017;21(1):300–6.

  56. Mustanski B, Ryan DT, Hayford C, Phillips G 2nd, Newcomb ME, Smith JD. 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. 2018;22(9):3044–56.

    PubMed  PubMed Central  Google Scholar 

  57. Oldenburg CE, Perez-Brumer AG, Hatzenbuehler ML, Krakower D, Novak DS, Mimiaga MJ, et al. State-level structural sexual stigma and HIV prevention in a national online sample of HIV-uninfected MSM in the United States. AIDS. 2015;29(7):837–45.

  58. Philbin MM, Parker CM, Parker RG, Wilson PA, Garcia J, Hirsch JS. Gendered social institutions and preventive healthcare seeking for Black men who have sex with men: the promise of biomedical HIV prevention. Arch Sex Behav. 2018;47(7):2091–100.

  59. Furukawa NW, Maksut JL, Zlotorzynska M, Sanchez TH, Smith DK, Baral SD. Sexuality disclosure in U.S. gay, bisexual, and other men who have sex with men: impact on healthcare-related stigmas and HIV pre-exposure prophylaxis denial. Am J Prev Med. 2020;59(2):e79–e87.

  60. Maloney KM, Krakower DS, Ziobro D, Rosenberger JG, Novak D, Mayer KH. Culturally competent sexual healthcare as a prerequisite for obtaining preexposure prophylaxis: findings from a qualitative study. LGBT Health. 2017;4(4):310–4.

    PubMed  PubMed Central  Google Scholar 

  61. U.S. Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States - 2017 update. 2018. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf. Accessed 15 Sept 2020.

  62. U.S. Food and Drug Administration. 2020. https://www.fda.gov/. Accessed 15 Sept 2020.

  63. Auerbach JD, Kinsky S, Brown G, Charles V. Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV. AIDS Patient Care STDS. 2015;29(2):102–10.

    PubMed  PubMed Central  Google Scholar 

  64. Calabrese SK, Earnshaw VA, Magnus M, Hansen NB, Krakower DS, Underhill K, et al. Sexual stereotypes ascribed to black men who have sex with men: an intersectional analysis. Arch Sex Behav. 2018;47(1):143–56.

  65. Brown G, Leonard W, Lyons A, Power J, Sander D, McColl W, et al. Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape. Sex Health. 2017;14(1):111–8 This article reviews the historical context for PrEP stigma as experienced by gay men and anticipates future challenges and opportunities.

    PubMed  Google Scholar 

  66. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach, 2nd ed. 2016. https://www.who.int/hiv/pub/arv/arv-2016/en/. Accessed 15 Sept 2020.

  67. Calabrese SK, Willie TC, Galvao RW, Tekeste M, Dovidio JF, Safon CB, et al. Current US guidelines for prescribing HIV pre-exposure prophylaxis (PrEP) disqualify many women who are at risk and motivated to use PrEP. J Acquir Immune Defic Syndr. 2019;81(4):395–405.

  68. Hodges-Mameletzis I, Dalal S, Msimanga-Radebe B, Rodolph M, Baggaley R. Going global: the adoption of the World Health Organization's enabling recommendation on oral pre-exposure prophylaxis for HIV. Sex Health. 2018;15(6):489–500.

    PubMed  Google Scholar 

  69. Parsons JT, Rendina HJ, Lassiter JM, Whitfield TH, Starks TJ, Grov C. Uptake of HIV pre-exposure prophylaxis (PrEP) in a national cohort of gay and bisexual men in the United States: the Motivational PrEP Cascade. J Acquir Immune Defic Syndr. 2017;4(3):285–92.

  70. Kelley CF, Kahle E, Siegler A, Sanchez T, Del Rio C, Sullivan PS, et al. Applying a PrEP continuum of care for men who have sex with men in Atlanta, Georgia. Clin Infect Dis. 2015;61(10):1590–7.

    PubMed  PubMed Central  Google Scholar 

  71. Shover CL, Javanbakht M, Shoptaw S, Bolan RK, Lee S-J, Parsons JT, et al. HIV preexposure prophylaxis initiation at a large community clinic: differences between eligibility, awareness, and uptake. Am J Public Health. 2018;108(10):1408–17.

  72. Tims-Cook Z. A retrospective assessment of antecedent pre-exposure prophylaxis eligibility of HIV-positive women in the south. AIDS Patient Care STDS. 2019;33(9):384–7.

    PubMed  Google Scholar 

  73. Hoots BE, Finlayson T, Nerlander L, Paz-Bailey G, NHBS Study Group. Willingness to take, use of, and indications for pre-exposure prophylaxis among men who have sex with men-20 US Cities, 2014. Clin Infect Dis. 2016;63(5):672–7.

  74. Sullivan PS, Rosenberg ES, Sanchez TH, Kelley CF, Luisi N, Cooper HL, et al. Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study. Ann Epidemiol. 2015;25(6):445–54.

  75. Blumenthal J, Jain S, Mulvihill E, Sun S, Hanashiro M, Ellorin E, et al. Perceived versus calculated HIV risk: implications for pre-exposure prophylaxis uptake in a randomized trial of men who have sex with men. J Acquir Immune Defic Syndr. 2019;80(2):e23–9.

  76. Kesler MA, Kaul R, Myers T, Liu J, Loutfy M, Remis RS, et al. Perceived HIV risk, actual sexual HIV risk and willingness to take pre-exposure prophylaxis among men who have sex with men in Toronto, Canada. AIDS Care. 2016;28(11):1378–85.

  77. Xie L, Wu Y, Meng S, Hou J, Fu R, Zheng H, et al. Risk behavior not associated with self-perception of PrEP candidacy: implications for designing PrEP services. AIDS Behav. 2019;23(10):2784–94.

  78. Jay JS, Gostin LO. Ethical challenges of preexposure prophylaxis for HIV. JAMA. 2012;308(9):867–8.

    CAS  PubMed  Google Scholar 

  79. Kessler J, Myers JE, Nucifora KA, Mensah N, Toohey C, Khademi A, et al. Evaluating the impact of prioritization of antiretroviral pre-exposure prophylaxis in New York. AIDS. 2014;28(18):2683–91.

  80. Philpott S. Social justice, public health ethics, and the use of HIV pre-exposure prophylaxis. Am J Prev Med. 2013;44(1 Suppl 2):S137–40.

    PubMed  Google Scholar 

  81. Amico KR, Bekker LG. Global PrEP roll-out: recommendations for programmatic success. Lancet HIV. 2019;6(2):e137-40.

  82. Rogers BG, Whiteley L, Haubrick KK, Mena LA, Brown LK. Intervention messaging about pre-exposure prophylaxis use among young, Black sexual minority men. AIDS Patient Care STDS. 2019;33(11):473–81.

    PubMed  PubMed Central  Google Scholar 

  83. Calabrese SK, Dovidio JF, Patel VV, Modrakovic D, Boone CA, Galvao RW et al. The stigmatizing effect of “targeting” US Black men who have sex with men in the social marketing of PrEP: a mixed methods study. 23rd International AIDS Conference (AIDS 2020), Abstract PED0973. Jul 2020; Virtual.

  84. Nakasone SE, Young I, Estcourt CS, Calliste J, Flowers P, Ridgway J, et al. Risk perception, safer sex practices and PrEP enthusiasm: barriers and facilitators to oral HIV pre-exposure prophylaxis in Black African and Black Caribbean women in the UK. Sex Transm Infect. 2020;96:349–54.

  85. Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson D, Mayer KH. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in Black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care. 2017;29(11):1351–8.

    PubMed  PubMed Central  Google Scholar 

  86. Calabrese SK, Underhill K, Earnshaw VA, Hansen NB, Kershaw TS, Magnus M, et al. Framing HIV pre-exposure prophylaxis (PrEP) for the general public: how inclusive messaging may prevent prejudice from diminishing public support. AIDS Behav. 2016;20(7):1499–513.

  87. Herek GM, Capitanio JP. AIDS stigma and sexual prejudice. Am Behav Sci. 1999;42(7):1130–47.

    Google Scholar 

  88. Fields EL, Long A, Bademosi K, Granderson R, Schumacher CM, Chandran A, et al. Identifying community-informed language to promote HIV pre-exposure prophylaxis (PrEP) in Black LGBTQ communities in Baltimore. AIDS Educ Prev. 2020;32(2):152–68.

  89. Fischer LS, Mansergh G, Lynch J, Santibanez S. Addressing disease-related stigma during infectious disease outbreaks. Disaster Med Public Health Prep. 2019;13(5–6):989–94.

    PubMed  PubMed Central  Google Scholar 

  90. Corrigan PW, Bink AB, Schmidt A. Reducing physical illness stigma: insights from the mental illness arena. In: Major B, Dovidio JF, Link BG, editors. The Oxford handbook of stigma, discrimination, and health. New York: Oxford University Press; 2018. p. 413–27.

  91. Livingston JD, Milne T, Fang ML, Amari E. The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review. Addiction. 2012;107(1):39–50.

    PubMed  PubMed Central  Google Scholar 

  92. Calabrese SK, Krakower DS, Mayer KH. Integrating HIV pre-exposure prophylaxis (PrEP) into routine preventive healthcare to avoid exacerbating disparities. Am J Public Health. 2017;107(12):1883–9.

    PubMed  PubMed Central  Google Scholar 

  93. O'Connell HR, Criniti SM. The impact of HIV pre-exposure prophylaxis (PrEP) counseling on PrEP knowledge and attitudes among women seeking family planning care. J Womens Health [journal on the Internet]. 3 Jun 2020 [cited 15 Sep 2020]. https://doi.org/10.1089/jwh.2019.8217.

  94. Marcus JL, Volk JE, Pinder J, Liu AY, Bacon O, Hare CB, et al. Successful implementation of HIV preexposure prophylaxis: lessons learned from three clinical settings. Curr HIV/AIDS Rep. 2016;13(2):116–24.

  95. Marcus JL, Levine K, Grasso C, Krakower DS, Powell V, Bernstein KT, et al. HIV preexposure prophylaxis as a gateway to primary care. Am J Public Health. 2018;108(10):1418–20.

  96. Friend DR, Clark JT, Kiser PF, Clark MR. Multipurpose prevention technologies: products in development. Antivir Res. 2013;100(Suppl):S39–47.

    CAS  PubMed  Google Scholar 

  97. Klein H, Washington TA. The pre-exposure prophylaxis (PrEP) stigma scale: preliminary findings from a pilot study. Int Public Health J. 2019;11(2):185–95.

    PubMed  PubMed Central  Google Scholar 

  98. Siegler AJ, Wiatrek S, Mouhanna F, Amico KR, Dominguez K, Jones J et al. Validation of the HIV Pre-Exposure Prophylaxis Stigma Scale: performance of likert and semantic differential scale versions. AIDS Behav. 2020;24(9):2637-49.

  99. Rogers EM. Diffusion of preventive innovations. Addict Behav. 2002;27(6):989–93.

    PubMed  Google Scholar 

  100. Calabrese SK, Galvao RW, Dovidio JF, Willie TC, Safon CB, Kaplan C, et al. Contraception as a potential gateway to pre-exposure prophylaxis: US women’s pre-exposure prophylaxis modality preferences align with their birth control practices. AIDS Patient Care STDS. 2020;34(3):132–46.

Download references

Author information

Authors and Affiliations

  1. Department of Psychological and Brain Sciences, The George Washington University, 2125 G Street NW, Washington, DC, 20052, USA

    Sarah K. Calabrese

  2. Department of Prevention and Community Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC, 20052, USA

    Sarah K. Calabrese

Authors
  1. Sarah K. Calabrese
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah K. Calabrese.

Ethics declarations

Conflict of Interest

Sarah Calabrese has received partial support from Gilead Sciences to attend a research conference.

Human and Animal Rights and Informed Consent

This article does not contain any new studies with human or animal subjects performed by the author.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Implementation Science

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Calabrese, S.K. Understanding, Contextualizing, and Addressing PrEP Stigma to Enhance PrEP Implementation. Curr HIV/AIDS Rep 17, 579–588 (2020). https://doi.org/10.1007/s11904-020-00533-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11904-020-00533-y

Keywords

Search

Navigation