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AIDS and Behavior
Published in: AIDS and Behavior 2/2014

01-02-2014 | Original Paper

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

Authors: Sarah K. Calabrese, Valerie A. Earnshaw, Kristen Underhill, Nathan B. Hansen, John F. Dovidio

Published in: AIDS and Behavior | Issue 2/2014

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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.
Literature
1.
Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.PubMedCentralPubMedCrossRef
2.
Thigpen MC, Kebaabetswe PM, Paxton LA, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34.PubMedCrossRef
3.
Baeten JM, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.PubMedCentralPubMedCrossRef
4.
5.
Hogben M, Liddon N. Disinhibition and risk compensation: scope, definitions, and perspective. Sex Transm Dis. 2008;35(12):1009–10.PubMed
6.
Tripathi A, Ogbuanu C, Monger M, Gibson JJ, Duffus WA. Preexposure prophylaxis for HIV infection: healthcare providers’ knowledge, perception, and willingness to adopt future implementation in the southern US. South Med J. 2012;105(4):199–206.PubMedCrossRef
7.
Centers for Disease Control and Prevention. Interim guidance: preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR Morb Mortal Wkly Rep. 2011;60(3):65–8.
8.
Centers for Disease Control and Prevention. Interim guidance for clinicians considering the use of preexposure prophylaxis for the prevention of HIV infection in heterosexually active adults. MMWR Morb Mortal Wkly Rep. 2012;61(31):586–9.
9.
Centers for Disease Control and Prevention. Update to Interim Guidance for Preexposure Prophylaxis (PrEP) for the Prevention of HIV Infection: PrEP for injecting drug users. MMWR Morb Mortal Wkly Rep. 2013;62(23):463–5.
10.
11.
World Health Organization. Guidance on pre-exposure oral prophylaxis (PrEP) for serodiscordant couples, men and transgender women who have sex with men at high risk of HIV: recommendations for use in the context of demonstration projects. Geneva: World Health Organization; 2012.
12.
Arnold EA, Hazelton P, Lane T, et al. A qualitative study of provider thoughts on implementing pre-exposure prophylaxis (PrEP) in clinical settings to prevent HIV infection. PLoS One. 2012;7(7):e40603.PubMedCentralPubMedCrossRef
13.
Puro V, Palummieri A, De Carli G, Piselli P, Ippolito G. Attitude towards antiretroviral pre-exposure prophylaxis (PrEP) prescription among HIV specialists. BMC Infect Dis. 2013;13(1):217–24.PubMedCentralPubMedCrossRef
14.
Bowleg L, Teti M, Massie JS, Patel A, Malebranche DJ, Tschann JM. ‘What does it take to be a man? What is a real man?’: ideologies of masculinity and HIV sexual risk among Black heterosexual men. Cult Health Sex. 2011;13(5):545–59.PubMedCentralPubMedCrossRef
15.
Bowleg L. “Once you’ve blended the cake, you can’t take the parts back to the main ingredients”: Black gay and bisexual men’s descriptions and experiences of intersectionality. Sex Roles. 2013;68(11–12):754–67.CrossRef
16.
Valentine JA. Impact of attitudes and beliefs regarding African American sexual behavior on STD prevention and control in African American communities: unintended consequences. Sex Transm Dis. 2008;35(12):S23–9.PubMedCrossRef
17.
Bogart LM, Catz SL, Kelly JA, Benotsch EG. Factors influencing physicians’ judgments of adherence and treatment decisions for patients with HIV disease. Med Decis Making. 2001;21(1):28–36.PubMedCrossRef
18.
King WD, Wong MD, Shapiro MF, Landon BE, Cunningham WE. Does racial concordance between HIV-positive patients and their physicians affect the time to receipt of protease inhibitors? J Gen Intern Med. 2004;19(11):1146–53.PubMedCentralPubMedCrossRef
19.
Shapiro MF, Morton SC, McCaffrey DF, et al. Variations in the care of HIV-infected adults in the United States—results from the HIV cost and services utilization study. JAMA. 1999;281(24):2305–15.PubMedCrossRef
20.
Stone VE. Physician contributions to disparities in HIV/AIDS care: the role of provider perceptions regarding adherence. Curr HIV/AIDS Rep. 2005;2:189–93.PubMedCrossRef
21.
Harrison DD, Cooke CW. An elucidation of factors influencing physicians’ willingness to perform elective female sterilization. Obstet Gynecol. 1988;72(4):565–70.PubMed
22.
Borrero S, Schwarz EB, Creinin M, Ibrahim S. The impact of race and ethnicity on receipt of family planning services in the United States. J Womens Health. 2009;18(1):91–6.CrossRef
23.
D’Amore MM, Cheng DM, Allensworth-Davies D, Samet JH, Saitz R. Disparities in safe sex counseling & behavior among individuals with substance dependence: a cross-sectional study. Reprod Health. 2012;9:35.PubMedCentralPubMedCrossRef
24.
Downing RA, LaVeist TA, Bullock HE. Intersections of ethnicity and social class in provider advice regarding reproductive health. Am J Public Health. 2007;97(10):1803–7.PubMedCrossRef
25.
26.
Abdool Karim SS, Gray GE, Martinson N. Clinical decisions. Preexposure prophylaxis for HIV prevention. N Engl J Med. 2012;367(5):462–5.PubMedCrossRef
27.
Maznavi K, Hardy D, Bredeek F. Pre-exposure prophylaxis (PrEP) for HIV: an online survey of HIV healthcare providers evaluating their knowledge, perception, and prescription of PrEP. Boston: Infectious Diseases Society of America Annual Meeting; 2011.
28.
Gaertner SL, Dovidio JF. Understanding and addressing contemporary racism: from aversive racism to the common ingroup identity model. J Soc Issues. 2005;61(3):615–39.CrossRef
29.
Aberson CL, Ettlin TE. The aversive racism paradigm and responses favoring African Americans: meta-analytic evidence of two types of favoritism. Soc Justice Res. 2004;17(1):25–46.CrossRef
30.
Dovidio JF, Gaertner SL. Aversive racism. Adv Exp Soc Psychol. 2004;36:1–52.CrossRef
31.
Geiger HJ. Racial and ethnic disparities in diagnosis and treatment: a review of the evidence and a consideration of causes. In: Smedley A, Stith A, Nelson A, editors. Unequal treatment: donfronting racial and ethnic disparities in health care. Washington, DC: National Academic Press; 2003. p. 417–54.
32.
Dovidio JF, Penner LA, Albrecht TL, Norton WE, Gaertner SL, Shelton JN. Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Soc Sci Med. 2008;67(3):478–86.PubMedCrossRef
33.
Dovidio JF, Fiske ST. Under the radar: how unexamined biases in decision-making processes in clinical interactions can contribute to health care disparities. Am J Public Health. 2012;102(5):945–52.PubMedCentralPubMedCrossRef
34.
Thorner AR, Rosenberg ES. Early versus delayed antiretroviral therapy in patients with HIV infection—a review of the current guidelines from an immunological perspective. Drugs. 2003;63(13):1325–37.PubMedCrossRef
35.
Mimiaga MJ, White JM, Krakower DS, Biello KB, Mayer KH. Suboptimal awareness and comprehension of published preexposure prophylaxis efficacy results among physicians in Massachusetts. AIDS Care. 2013. Epub 2013/10/15.
36.
White JM, Mimiaga MJ, Krakower DS, Mayer KH. Evolution of Massachusetts physician attitudes, knowledge, and experience regarding the use of antiretrovirals for HIV prevention. AIDS Patient Care STDs. 2012;26(7):395–405.PubMed
37.
Senn H, Wilton J, Sharma M, Fowler S, Tan DH. Knowledge of and opinions on HIV preexposure prophylaxis among front-line service providers at Canadian AIDS service organizations. AIDS Res Hum Retroviruses. 2013;29(9):1183–9.PubMed
38.
Hedlund J. Risky business: safety regulations, risk compensation, and individual behavior. Inj Prev. 2000;6:82–90.PubMedCrossRef
39.
Cassell MM, Halperin DT, Shelton JD, Stanton D. Risk compensation: the Achilles’ heel of innovations in HIV prevention? BMJ. 2006;332(7541):605–7.PubMedCrossRef
40.
Eaton LA, Kalichman S. Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies. Curr HIV/AIDS Rep. 2007;4(4):165–72.PubMedCentralPubMedCrossRef
41.
Golub SA, Kowalczyk W, Weinberger CL, Parsons JT. Preexposure prophylaxis and predicted condom use among high-risk men who have sex with men. J Acquir Immune Defic Syndr. 2010;54(5):548–55.PubMedCentralPubMedCrossRef
42.
Smith DK, Toledo L, Smith DJ, Adams MA, Rothenberg R. Attitudes and program preferences of African-American urban young adults about pre-exposure prophylaxis (PrEP). AIDS Educ Prev. 2012;24(5):408–21.PubMedCrossRef
43.
Underhill K, Morrow KM, Operario D, Ducharme R, Kuo C, Mayer KH. Project PrEP talk: an in-depth qualitative analysis of PrEP acceptability, expectations and risk compensation beliefs among United States MSM. XIX International AIDS Conference. Washington, DC, 2012.
44.
Krakower D, Mimiaga M, Rosenberger J et al. Anticipated risk compensation with pre-exposure prophylaxis use among North American men who have sex with men using an internet social network. XIX International AIDS Conference. Washington, DC, 2012.
45.
Brooks RA, Landovitz RJ, Kaplan RL, Lieber E, Lee SJ, Barkley TW. Sexual risk behaviors and acceptability of HIV pre-exposure prophylaxis among HIV-negative gay and bisexual men in serodiscordant relationships: a mixed methods study. AIDS Patient Care STDS. 2012;26(2):87–94.PubMedCrossRef
46.
Koblin BA, Mansergh G, Frye V, et al. Condom-use decision making in the context of hypothetical pre-exposure prophylaxis efficacy among substance-using men who have sex with men: Project MIX. J Acquir Immune Defic Syndr. 2011;58(3):319–27.PubMedCrossRef
47.
Paltiel AD, Freedberg KA, Scott CA, et al. HIV preexposure prophylaxis in the United States: impact on lifetime infection risk, clinical outcomes, and cost-effectiveness. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:806–15.PubMedCentralPubMedCrossRef
48.
Desai K, Sansom SL, Ackers ML, Stewart SR, Hall HI, Hu DJ, et al. Modeling the impact of HIV chemoprophylaxis strategies among men who have sex with men in the United States: HIV infections prevented and cost-effectiveness. AIDS. 2008;22:1829–39.PubMedCrossRef
49.
Gray R, Kigozi G, Kong X, et al. The effectiveness of male circumcision for HIV prevention and effects on risk behaviors in a posttrial follow-up study. AIDS. 2012;26(5):609–15.PubMedCrossRef
50.
Kong X, Kigozi G, Nalugoda F, et al. Assessment of changes in risk behaviors during 3 years of posttrial follow-up of male circumcision trial participants uncircumcised at trial closure in Rakai, Uganda. Am J Epidemiol. 2012;176(10):875–85.PubMedCrossRef
51.
Kalichman S, Eaton L, Pinkerton S. Circumcision for HIV prevention: failure to fully account for behavioral risk compensation. PLoS Med. 2007;4(3):e138.PubMedCentralPubMedCrossRef
52.
Gust DA, Kretsinger K, Pals SL, Gaul ZJ, Hefflefinger JD, Begley EB, et al. Male circumcision as an HIV prevention intervention in the US: influence of health care providers and potential for risk compensation. Prev Med. 2011;52(3–4):270–3.PubMed
53.
Pinkerton SD. Sexual risk compensation and HIV/STD transmission: empirical evidence and theoretical considerations. Risk Anal. 2001;21(4):727–36.PubMedCrossRef
54.
Crepaz N, Hart TA, Marks G. Highly active antiretroviral therapy and sexual risk behavior: a meta-analytic review. JAMA. 2004;292(2):224–36.PubMedCrossRef
55.
Guest G, Shattuck D, Johnson L, et al. Changes in sexual risk behavior among participants in a PrEP HIV prevention trial. Sex Transm Dis. 2008;35(12):1002–8.PubMed
56.
57.
Choopanya K, Martin M, Suntharasamai P, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2013;381(9883):2083–90.PubMedCrossRef
58.
Underhill K. Study designs for identifying risk compensation behavior among users of biomedical HIV prevention technologies: balancing methodological rigor and research ethics. Soc Sci Med. 2013;94:115–23.PubMedCrossRef
59.
Mugwanya KK, Donnell D, Celum C, Thomas KK, Ndase P, Mugo N, et al. Sexual behaviour of heterosexual men and women receiving antiretroviral pre-exposure prophylaxis for HIV prevention: a longitudinal analysis. Lancet Infect Dis. 2013. Epub 2013/10/22.
60.
Greenwald AG, Banaji MR. Implicit social cognition: attitudes, self-esteem, and stereotypes. Psychol Rev. 1995;102(1):4–27.PubMedCrossRef
61.
Jost JT, Banaji MR. The role of stereotyping in system-justification and the production of false consciousness. Br J Soc Psychol. 1994;33:1–27.CrossRef
62.
Thorburn S, Bogart LM. African American women and family planning services: perceptions of discrimination. Women Health. 2005;42(1):23–39.PubMedCrossRef
63.
Saleh LD, Operario D. Moving beyond “the Down Low”: a critical analysis of terminology guiding HIV prevention efforts for African American men who have secretive sex with men. Soc Sci Med. 2009;68(2):390–5.PubMedCrossRef
64.
Ford CL, Whetten KD, Hall SA, Kaufman JS, Thrasher AD. Black sexuality, social construction, and research targeting ‘the Down Low’ (‘the DL’). Ann Epidemiol. 2007;17(3):209–16.PubMedCrossRef
65.
Millett GA, Peterson JL, Flores SA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet. 2012;380(9839):341–8.PubMedCrossRef
66.
Millett GA, Peterson JL, Wolitski RJ, Stall R. Greater risk for HIV infection of black men who have sex with men: a critical literature review. Am J Public Health. 2006;96(6):1007–19.PubMedCrossRef
67.
Feldman MB. A critical literature review to identify possible causes of higher rates of HIV infection among young Black and Latino men who have sex with men. J Natl Med Assoc. 2010;102(12):1206–21.PubMed
68.
69.
70.
Shrout PE, Bolger N. Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychol Methods. 2002;7(4):422–45.PubMedCrossRef
71.
Hayes AF. Beyond Baron and Kenny: statistical mediation analysis in the new millennium. Commun Monogr. 2009;76(4):408–20.CrossRef
72.
Hayes AF. An introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: Guilford Press; 2013.
73.
74.
Malebranche DJ, Peterson JL, Fullilove RE, Stackhouse RW. Race and sexual identity: perceptions about medical culture and healthcare among Black men who have sex with men. J Natl Med Assoc. 2004;96(1):97–107.PubMed
75.
Amodio DM, Devine PG. Stereotyping and evaluation in implicit race bias: evidence for independent constructs and unique effects on behavior. J Pers Soc Psychol. 2006;91(4):652–61.PubMedCrossRef
76.
Amodio DM, Ratner KG. A memory systems model of implicit social cognition. Curr Dir Psychol Sci. 2011;20(3):143–8.CrossRef
77.
Mera RM, Rawlings MK, Pechonkina A, Rooney JF, Peschel T, Cheng A. Status of Truvada (TVD) for HIV pre-exposure prophylaxis (PrEP) in the United States: an early drug utilization analysis. Interscience Conference on Antimicrobial Agents and Chemotherapy. Denver, 2013.
78.
Underhill K, Operario D, Skeer M, Mimiaga M, Mayer K. Packaging PrEP to prevent HIV: an integrated framework to plan for pre-exposure prophylaxis implementation in clinical practice. J Acquir Immune Defic Syndr. 2010;55(1):8–13.PubMedCentralPubMedCrossRef
79.
Wheeler ME, Fiske ST. Controlling racial prejudice: social-cognitive goals affect amygdala and stereotype activation. Psychol Sci. 2005;16(1):56–63.PubMedCrossRef
80.
Burgess D, van Ryn M, Dovidio J, Saha S. Reducing racial bias among health care providers: lessons from social-cognitive psychology. J Gen Intern Med. 2007;22(6):882–7.PubMedCentralPubMedCrossRef
81.
Penner LA, Gaertner S, Dovidio JF, et al. A social psychological approach to improving the outcomes of racially discordant medical interactions. J Gen Intern Med. 2013;28(9):1143–9.PubMedCrossRef
82.
83.
Teal CR, Shada RE, Gill AC, et al. When best intentions aren’t enough: helping medical students develop strategies for managing bias about patients. J Gen Intern Med. 2010;25(Suppl 2):S115–8.PubMedCrossRef
84.
Boutin-Foster C, Foster JC, Konopasek L. Viewpoint: physician, know thyself: the professional culture of medicine as a framework for teaching cultural competence. Acad Med. 2008;83(1):106–11.PubMedCrossRef
85.
Novack DH, Epstein RM, Paulsen RH. Toward creating physician-healers: fostering medical students’ self-awareness, personal growth, and well-being. Acad Med. 1999;74(5):516–20.PubMedCrossRef
86.
Newheiser AK, Dovidio JF. Individual differences and intergroup bias: divergent dynamics associated with prejudice and stereotyping. Pers Individ Dif. 2012;53(1):70–4.CrossRef
87.
Greenwald AG, Poehlman TA, Uhlmann EL, Banaji MR. Understanding and using the implicit association test: III. Meta-analysis of predictive validity. J Pers Soc Psychol. 2009;97(1):17–41.PubMedCrossRef
88.
Veloski J, Tai S, Evans AS, Nash DB. Clinical vignette-based surveys: a tool for assessing physician practice variation. Am J Med Qual. 2005;20(3):151–7.PubMedCrossRef
89.
Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M. Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA. 2000;283(13):1715–22.PubMedCrossRef
90.
91.
Cohen SE, Liu AY, Bernstein KT, Philip S. Preparing for HIV pre-exposure prophylaxis: lessons learned from post-exposure prophylaxis. Am J Prev Med. 2013;44(Suppl 2):S80–5.PubMedCentralPubMedCrossRef
92.
Galindo GR, Walker JJ, Hazelton P, et al. Community member perspectives from transgender women and men who have sex with men on pre-exposure prophylaxis as an HIV prevention strategy: implications for implementation. Implement Sci. 2012;7:116.PubMedCentralPubMedCrossRef
93.
Jay JS, Gostin LO. Ethical challenges of preexposure prophylaxis for HIV. JAMA. 2012;308(9):867–8.PubMedCrossRef
94.
Rennie S. Ethical use of antiretroviral resources for HIV prevention in resource poor settings. Dev World Bioeth. 2013;13(2):79–86.PubMedCrossRef
95.
Underhill K, Operario D, Mimiaga MJ, Skeer MR, Mayer KH. Implementation science of pre-exposure prophylaxis: preparing for public use. Curr HIV/AIDS Rep. 2010;7(4):210–9.PubMedCentralPubMedCrossRef
96.
Metadata
Title
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
Authors
Sarah K. Calabrese
Valerie A. Earnshaw
Kristen Underhill
Nathan B. Hansen
John F. Dovidio
Publication date
01-02-2014
Publisher
Springer US
Published in
AIDS and Behavior / Issue 2/2014
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-013-0675-x

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