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AIDS and Behavior
Published in: AIDS and Behavior 11/2019

01-11-2019 | Care | Original Paper

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

Authors: Whitney S. Rice, Kristi L. Stringer, Maira Sohail, Kaylee B. Crockett, Ghislaine C. Atkins, Kachina Kudroff, D. Scott Batey, Joshua Hicks, Janet M. Turan, Michael J. Mugavero, Bulent Turan

Published in: AIDS and Behavior | Issue 11/2019

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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.
Literature
1.
2.
Adimora AA, Ramirez C, Schoenbach VJ, Cohen MS. Policies and politics that promote HIV infection in the Southern United States. AIDS. 2014;28(10):1393–7.PubMedPubMedCentral
3.
4.
Sullivan PS, Purcell DW, Grey JA, Bernstein KT, Gift TL, Wimbly TA, et al. Patterns of racial/ethnic disparities and prevalence in HIV and syphilis diagnoses among men who have sex with men, 2016: a novel data visualization. Am J Public Health. 2018;108(S4):S266–73.PubMedPubMedCentral
5.
Clark H, Babu AS, Wiewel EW, Opoku J, Crepaz N. Diagnosed HIV infection in transgender adults and adolescents: results from the national HIV surveillance system, 2009–2014. AIDS Behav. 2017;21(9):2774–83.PubMedPubMedCentral
6.
Nwangwu-Ike N, Frazier EL, Crepaz N, Tie Y, Sutton MY. Racial and ethnic differences in viral suppression among HIV-positive women in care. J Acquir Immune Defic Syndr. 2018;79(2):e56–68.PubMed
7.
Lesko CR, Cole SR, Miller WC, Westreich D, Eron JJ, Adimora AA, et al. Ten-year survival by race/ethnicity and sex among treated, HIV-infected adults in the United States. Clin Infect Dis. 2015;60(11):1700–7.PubMedPubMedCentral
8.
Kramer MR, Black NC, Matthews SA, James SA. The legacy of slavery and contemporary declines in heart disease mortality in the U.S. South. SSM—Popul Health. 2017;3:609–17.PubMedPubMedCentral
9.
Watkins-Hayes C. Intersectionality and the sociology of HIV/AIDS: past, present, and future research directions. Annu Rev Sociol. 2014;40(1):431–57.
10.
Roberts D. Killing the black body: race, reproduction, and the meaning of liberty. New York: Knopf Doubleday Publishing Group; 2014.
11.
Gubrium AC, Mann ES, Borrero S, Dehlendorf C, Fields J, Geronimus AT, et al. Realizing reproductive health equity needs more than long-acting reversible contraception (LARC). Washington, DC: American Public Health Association; 2016. p. 18–9.
12.
U.S. Centers for Disease Control and Prevention. Pre-exposure prophylaxis for the prevention of HIV infection in the United States—2014: a clinical practice guideline. Atlanta, GA: U.S. Department of Health and Human Services, U.S. Public Health Service; 2014.
13.
Siegler AJ, Mouhanna F, Giler RM, Weiss K, Pembleton E, Guest J, et al. The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis-to-need ratio in the fourth quarter of 2017, United States. Ann Epidemiol. 2018;28(12):841–9.PubMed
14.
15.
Elopre L, Kudroff K, Westfall AO, Overton ET, Mugavero MJ. Brief report: the right people, right places, and right practices: disparities in PrEP access among African American men, women, and MSM in the Deep South. J Acquir Immune Defic Syndr. 2017;74(1):56–9.PubMedPubMedCentral
16.
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.PubMedPubMedCentral
17.
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.PubMedPubMedCentral
18.
Koechlin FM, Fonner VA, Dalglish SL, O’Reilly KR, Baggaley R, Grant RM, et al. Values and preferences on the use of oral pre-exposure prophylaxis (PrEP) for HIV prevention among multiple populations: a systematic review of the literature. AIDS Behav. 2017;21(5):1325–35.PubMed
19.
Galindo GR, Walker JNJ, Hazelton P, Lane T, Steward WT, Morin SF, 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 IS. 2012;7:116.PubMed
20.
Krakower D, Ware N, Mitty JA, Maloney K, Mayer KH. HIV providers’ perceived barriers and facilitators to implementing pre-exposure prophylaxis in care settings: a qualitative study. AIDS Behav. 2014;18(9):1712–21.PubMedPubMedCentral
21.
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.PubMedPubMedCentral
22.
Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDs. 2013;27(4):248–54.PubMedPubMedCentral
23.
Flash CA, Stone VE, Mitty JA, Mimiaga MJ, Hall KT, Krakower D, et al. Perspectives on HIV prevention among Urban black women: a potential role for HIV pre-exposure prophylaxis. AIDS Patient Care STDs. 2014;28(12):635–42.PubMedPubMedCentral
24.
Liu A, Cohen S, Follansbee S, Cohan D, Weber S, Sachdev D, et al. Early experiences implementing pre-exposure prophylaxis (PrEP) for HIV prevention in San Francisco. PLoS Med. 2014;11(3):e1001613.PubMedPubMedCentral
25.
Desai M, Gafos M, Dolling D, McCormack S, Nardone A. Healthcare providers’ knowledge of, attitudes to and practice of pre-exposure prophylaxis for HIV infection. HIV Med. 2016;17(2):133–42.PubMed
26.
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;13:217.PubMedPubMedCentral
27.
Corneli A, Perry B, McKenna K, Agot K, Ahmed K, Taylor J, et al. Participants’ explanations for nonadherence in the FEM-PrEP clinical trial. J Acquir Immune Defic Syndr. 2016;71(4):452–61.PubMed
28.
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.PubMed
29.
Corneli A, Wang M, Agot K, Ahmed K, Lombaard J, Van Damme L. Perception of HIV risk and adherence to a daily, investigational pill for HIV prevention in FEM-PrEP. J Acquir Immune Defic Syndr. 2014;67(5):555–63.PubMed
30.
Khawcharoenporn T, Kendrick S, Smith K. HIV risk perception and preexposure prophylaxis interest among a heterosexual population visiting a sexually transmitted infection clinic. AIDS Patient Care STDs. 2012;26(4):222–33.PubMed
31.
Guest G, Shattuck D, Johnson L, Akumatey B, Clarke EE, Chen PL, et al. Acceptability of PrEP for HIV prevention among women at high risk for HIV. J Womens Health (Larchmt). 2010;19(4):791–8.
32.
Wingood GM, Dunkle K, Camp C, Patel S, Painter JE, Rubtsova A, et al. Racial differences and correlates of potential adoption of preexposure prophylaxis: results of a national survey. J Acquir Immune Defic Syndr (1999). 2013;63(Suppl 1(0 1)):S95–101.PubMedCentral
33.
Mullins TLK, Lally M, Zimet G, Kahn JA. Adolescent medicine trials network for HIVAI. Clinician attitudes toward CDC interim pre-exposure prophylaxis (PrEP) guidance and operationalizing PrEP for adolescents. AIDS Patient Care STDs. 2015;29(4):193–203.PubMedPubMedCentral
34.
Senn H, Wilton J, Sharma M, Fowler S, Tan DHS. 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.PubMedPubMedCentral
35.
Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18.PubMedPubMedCentral
36.
Fauk NK, Sukmawati AS, Berek PAL, Ernawati, Kristanti E, Wardojo SSI, et al. Barriers to HIV testing among male clients of female sex workers in Indonesia. Int J Equity Health. 2018;17(1):68.PubMedPubMedCentral
37.
Meehan SA, Rossouw L, Sloot R, Burger R, Beyers N. Access to human immunodeficiency virus testing services in Cape Town, South Africa: a user perspective. Public Health Action. 2017;7(4):251–7.PubMedPubMedCentral
38.
Yakob B, Ncama BP. Correlates of strengthening lessons from HIV/AIDS treatment and care services in Ethiopia perceived access and implications for health system. PLoS ONE. 2016;11(8):e0161553.PubMedPubMedCentral
39.
Gesesew HA, Ward P, Woldemichael K, Mwanri L. Late presentation for HIV care in Southwest Ethiopia in 2003–2015: prevalence, trend, outcomes and risk factors. BMC Infect Dis. 2018;18(1):59.PubMedPubMedCentral
40.
Nunn AS, Brinkley-Rubinstein L, Oldenburg CE, Mayer KH, Mimiaga M, Patel R, et al. Defining the HIV pre-exposure prophylaxis care continuum. AIDS. 2017;31(5):731–4.PubMedPubMedCentral
41.
Mayer KH, Chan PA, Patel RR, Flash CA, Krakower DS. Evolving models and ongoing challenges for HIV preexposure prophylaxis implementation in the United States. J Acquir Immune Defic Syndr. 2018;77(2):119–27.PubMedPubMedCentral
42.
43.
Siegler AJ, Bratcher A, Weiss KM, Mouhanna F, Ahlschlager L, Sullivan PS. Location location location: an exploration of disparities in access to publicly listed pre-exposure prophylaxis clinics in the United States. Ann Epidemiol. 2018;28(12):858–64.PubMed
44.
45.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
46.
QSR International Pty Ltd. NVivo qualitative data analysis software. Victoria: QSR International Pty Ltd.; 2015.
47.
Hubach RD, Currin JM, Sanders CA, Durham AR, Kavanaugh KE, Wheeler DL, et al. Barriers to access and adoption of pre-exposure prophylaxis for the prevention of HIV among men who have sex with men (MSM) in a relatively rural state. AIDS Educ Prev. 2017;29(4):315–29.PubMed
48.
Underhill K, Morrow KM, Colleran C, Holcomb R, Calabrese SK, Operario D, et al. A qualitative study of medical mistrust, perceived discrimination, and risk behavior disclosure to clinicians by U.S. Male sex workers and other men who have sex with men: implications for biomedical HIV prevention. J Urban Health. 2015;92(4):667–86.PubMedPubMedCentral
49.
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.PubMedPubMedCentral
50.
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.PubMedPubMedCentral
51.
52.
Goswami ND, Schmitz MM, Sanchez T, Dasgupta S, Sullivan P, Cooper H, et al. Understanding local spatial variation along the care continuum: the potential impact of transportation vulnerability on HIV linkage to care and viral suppression in high-poverty areas, Atlanta, Georgia. J Acquir Immune Defic Syndr. 2016;72(1):65–72.PubMedPubMedCentral
53.
Fontenot K, Semega J, Kollar M. Income and poverty in the United States: 2017. Suitland: U.S. Census Bureau; 2017.
54.
Eaton LA, Driffin DD, Bauermeister J, Smith H, Conway-Washington C. Minimal awareness and stalled uptake of pre-exposure prophylaxis (PrEP) among at risk, HIV-negative, black men who have sex with men. AIDS Patient Care STDS. 2015;29(8):423–9.PubMedPubMedCentral
55.
Fletcher FE, Fisher C, Buchberg MK, Floyd B, Hotton A, Ehioba A, et al. “Where did this [PrEP] Come From?” African American mother/daughter perceptions related to adolescent preexposure prophylaxis (PrEP) utilization and clinical trial participation. J Empir Res Hum Res Ethics (JERHRE). 2018;13(2):173–84.PubMed
56.
Copeland RM, Wilson P, Betancourt G, Garcia D, Penner M, Abravanel R, et al. Disparities in HIV knowledge and attitudes toward biomedical interventions among the non-medical HIV workforce in the United States. AIDS Care. 2017;29(12):1576–84.PubMed
57.
58.
García M, Harris AL. PrEP awareness and decision-making for Latino MSM in San Antonio, Texas. PLoS ONE. 2017;12(9):e0184014.PubMedPubMedCentral
59.
Collier KL, Colarossi LG, Sanders K. Raising awareness of pre-exposure prophylaxis (PrEP) among women in New York City: Community and Provider Perspectives. J Health Commun. 2017;22(3):183–9.PubMed
60.
Whiteside YO, Harris T, Scanlon C, Clarkson S, Duffus W. Self-perceived risk of HIV infection and attitudes about preexposure prophylaxis among sexually transmitted disease clinic attendees in South Carolina. AIDS Patient Care STDs. 2011;25(6):365–70.PubMed
61.
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.PubMed
62.
National Academies of Sciences E, Medicine. Ending discrimination against people with mental and substance use disorders: the evidence for stigma change. Washington, DC: The National Academies Press; 2016.
63.
Batey DS, Whitfield S, Mulla M, Stringer KL, Durojaiye M, McCormick L, et al. Adaptation and implementation of an intervention to reduce HIV-related stigma among healthcare workers in the United States: piloting of the FRESH workshop. AIDS Patient Care STDS. 2016;30(11):519–27.PubMedPubMedCentral
64.
Raifman JR, Flynn C, German D. Healthcare provider contact and pre-exposure prophylaxis in baltimore men who have sex with men. Am J Prev Med. 2017;52(1):55–63.PubMed
65.
Zhang HL, Rhea SK, Hurt CB, Mobley VL, Swygard H, Sena AC, et al. HIV preexposure prophylaxis implementation at local health departments: a statewide assessment of activities and barriers. J Acquir Defic Syndr. 2018;77(1):72–7.
66.
John SA, Rendina HJ, Grov C, Parsons JT. Home-based pre-exposure prophylaxis (PrEP) services for gay and bisexual men: an opportunity to address barriers to PrEP uptake and persistence. PLoS ONE. 2017;12(12):e0189794.PubMedPubMedCentral
67.
Siegler AJ, Mayer KH, Liu AY, Patel RR, Ahlschlager LM, Kraft CS, et al. Developing and assessing the feasibility of a home-based PrEP monitoring and support program. Clin Infect Dis. 2018;68(3):501–4.PubMedCentral
68.
69.
Pinto RM, Berringer KR, Melendez R, Mmeje O. Improving PrEP implementation through multilevel interventions: a synthesis of the literature. AIDS Behav. 2018;22(11):3681–91.PubMedPubMedCentral
70.
Patel RR, Mena L, Nunn A, McBride T, Harrison LC, Oldenburg CE, et al. Impact of insurance coverage on utilization of pre-exposure prophylaxis for HIV prevention. PLoS ONE. 2017;12(5):e0178737.PubMedPubMedCentral
71.
Rowniak S, Ong-Flaherty C, Selix N, Kowell N. Attitudes, beliefs, and barriers to PrEP among trans men. AIDS Educ Prev. 2017;29(4):302–14.PubMed
72.
Spinelli MA, Scott HM, Vittinghoff E, Liu AY, Morehead-Gee A, Gonzalez R, et al. A panel management and patient navigation intervention is associated with earlier PrEP initiation in a safety-net primary care health system. J Acquir Immune Defic Syndr. 2018;79(3):347–51.PubMed
73.
Saberi P, Berrean B, Thomas S, Gandhi M, Scott H. A simple pre-exposure prophylaxis (PrEP) optimization intervention for health care providers prescribing PrEP: pilot study. JMIR Form Res. 2018;2(1):e2.PubMedPubMedCentral
74.
75.
76.
Aaron E, Blum C, Seidman D, Hoyt MJ, Simone J, Sullivan M, et al. Optimizing delivery of HIV preexposure prophylaxis for women in the United States. AIDS Patient Care STDS. 2018;32(1):16–23.PubMedPubMedCentral
77.
Smith DK, Mendoza MC, Stryker JE, Rose CE. PrEP awareness and attitudes in a national survey of primary care clinicians in the United States, 2009–2015. PLoS ONE. 2016;11(6):e0156592.PubMedPubMedCentral
78.
Calabrese SK, Magnus M, Mayer KH, Krakower DS, Eldahan AI, Hawkins LAG, et al. “Support your client at the space that they’re in”: HIV pre-exposure prophylaxis (PrEP) prescribers’ perspectives on PrEP-related risk compensation. AIDS Patient Care STDS. 2017;31(4):196–204.PubMedPubMedCentral
79.
Gaist P, Stirratt MJ. The roles of behavioral and social science research in the fight against HIV/AIDS: a functional framework. J Acquir Immune Defic Syndr. 2017;75(4):371–81.PubMed
Metadata
Title
Accessing Pre-exposure Prophylaxis (PrEP): Perceptions of Current and Potential PrEP Users in Birmingham, Alabama
Authors
Whitney S. Rice
Kristi L. Stringer
Maira Sohail
Kaylee B. Crockett
Ghislaine C. Atkins
Kachina Kudroff
D. Scott Batey
Joshua Hicks
Janet M. Turan
Michael J. Mugavero
Bulent Turan
Publication date
01-11-2019
Publisher
Springer US
Published in
AIDS and Behavior / Issue 11/2019
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-019-02591-9

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