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AIDS and Behavior
Published in: AIDS and Behavior 4/2018

01-04-2018 | Original Paper

A Closer Look at Racism and Heterosexism in Medical Students’ Clinical Decision-Making Related to HIV Pre-Exposure Prophylaxis (PrEP): Implications for PrEP Education

Authors: Sarah K. Calabrese, Valerie A. Earnshaw, Douglas S. Krakower, Kristen Underhill, Wilson Vincent, Manya Magnus, Nathan B. Hansen, Trace S. Kershaw, Kenneth H. Mayer, Joseph R. Betancourt, John F. Dovidio

Published in: AIDS and Behavior | Issue 4/2018

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Abstract

Social biases among healthcare providers could limit PrEP access. In this survey study of 115 US medical students, we examined associations between biases (racism and heterosexism) and PrEP clinical decision-making and explored prior PrEP education as a potential buffer. After viewing a vignette about a PrEP-seeking MSM patient, participants reported anticipated patient behavior (condomless sex, extra-relational sex, and adherence), intention to prescribe PrEP to the patient, biases, and background characteristics. Minimal evidence for racism affecting clinical decision-making emerged. In unadjusted analyses, heterosexism indirectly affected prescribing intention via all anticipated behaviors, tested as parallel mediators. Participants expressing greater heterosexism more strongly anticipated increased risk behavior and adherence problems, which were associated with lower prescribing intention. The indirect effect via condomless sex remained significant adjusting for background characteristics. Prior PrEP education did not buffer any indirect effects. Heterosexism may compromise PrEP provision to MSM and should be addressed in PrEP-related medical education.
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Metadata
Title
A Closer Look at Racism and Heterosexism in Medical Students’ Clinical Decision-Making Related to HIV Pre-Exposure Prophylaxis (PrEP): Implications for PrEP Education
Authors
Sarah K. Calabrese
Valerie A. Earnshaw
Douglas S. Krakower
Kristen Underhill
Wilson Vincent
Manya Magnus
Nathan B. Hansen
Trace S. Kershaw
Kenneth H. Mayer
Joseph R. Betancourt
John F. Dovidio
Publication date
01-04-2018
Publisher
Springer US
Published in
AIDS and Behavior / Issue 4/2018
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-017-1979-z

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