Social and structural factors associated with interest in HIV preexposure prophylaxis among Black women in the United States

ABSTRACT

In a nationwide sample of cisgender Black women in the US, we assessed the associations between social and structural factors and interest in using HIV preexposure prophylaxis (PrEP). Among 315 respondents, 62.2% were interested in PrEP if it were provided for free. Positive social norms surrounding PrEP, including injunctive norms (perceived social acceptability of PrEP use) and descriptive norms (perceived commonality of PrEP use), were positively associated with interest in using PrEP. Concerns about HIV infection, recently visiting a health care provider, and comfort discussing PrEP with a provider were also positively associated with interest in using PrEP. Anticipating PrEP disapproval from others was negatively associated with interest in PrEP. Although PrEP can promote autonomy and personal discretion, Black women’s PrEP-related decisions occur in a complex social environment. Black women may benefit from interventions to promote positive norms and attitudes surrounding PrEP at the community level and empower them in discussions with their providers about PrEP.

KEYWORDS:

• Black women
• HIV prevention
• preexposure prophylaxis (PrEP)
• social norms
• stigma
• SDG 3: good health and well-being
• SDG 10: reduced inequalities

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval

All procedures performed in this study were in accordance with the ethical standards of the Institutional Review Board at Washington University in St. Louis. (IRB201902109) and with the 1964 Helsinki declaration and its later amendments.

Additional information

Funding

This publication was made possible by Whitney Irie at Harvard University [grant number T32 AI007433] from the National Institute of Allergy and Infectious Diseases. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. WCI, SKC, and KHM have received funds to develop and deliver medical education related to PrEP. WCI receives medical education grants related to PrEP from ViiV Healthcare. SKC has received funds to develop medical education content for Virology Education and for her role as a consultant to Loma Linda University. KHM has conducted research funded by grants to Fenway Health from Gilead Sciences and Merck. He has served on Scientific Advisory Boards for Gilead Sciences and Merck and has received personal funds for development of educational content for UpToDate, Inc. OJB receives honoraria as a member of ViiV Healthcare's Health Equity Advisory Board, as a speaker for ViiV educational initiatives about HIV and women, and as a speaker for Gilead about HIV-related health inequities. EHG receives educational grants from ViiV Healthcare outside the submitted work. JLM has no disclosures.