Barriers and Facilitators to Pre-exposure Prophylaxis Uptake Among Black Women: A Qualitative Analysis Guided by a Socioecological Model

• Published in: The Journal of the Association of Nurses in AIDS Care Vol. 32; no. 4; pp. 481 - 494
• Main Authors: D'Angelo, Alexa B., Davis Ewart, Leah N., Koken, Juline, Bimbi, David, Brown, Justin T., Grov, Christian
• Format: Journal Article
• Language: English
• Published: United States Association of Nurses in AIDS Care 01.07.2021; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Barriers; Black people; Disease prevention; Efficacy; Female; Health care access; Health Knowledge, Attitudes, Practice; Health Services Accessibility; HIV; HIV Infections - drug therapy; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Individual differences; Monogamy; Pre-Exposure Prophylaxis; Qualitative research; Risk perception; Sociocultural factors; Stigma; Trust; Uptake; Women; Womens health
• ISSN: 1055-3290; 1552-6917; 1552-6917
• DOI: 10.1097/JNC.0000000000000241

Black women experience disparities in HIV incidence. Pre-exposure prophylaxis (PrEP) is a once-daily pill that can prevent HIV transmission. To enhance PrEP uptake among Black women, it is essential to examine their perceptions of PrEP. In 2018, 33 Black women in New York City completed interviews about their attitudes, knowledge, and perceived barriers and facilitators to PrEP use. Emergent themes were organized using a socioecological model. Participants identified barriers at the sociocultural level, including stigma, medical mistrust, and health care avoidance. At the community level, health care access issues and limited community knowledge were reported. Partner-level barriers included trust in partners and meaning attributed to PrEP use within the context of monogamy. Individual-level barriers included low perceived risk and concerns about PrEP's safety and efficacy. Our findings can inform future PrEP research with Black women, as well as PrEP implementation efforts aimed at increasing uptake among this population.