PrEP Stigma and logistical barriers remain significant challenges in curtailing HIV transmission among Black and Hispanic/Latinx cisgender sexual minority men and transgender women in the US

ABSTRACT

Despite advancements in HIV prevention, such as pre-exposure prophylaxis (PrEP), there remain inequities in accessing PrEP among Black and Hispanic/Latinx cisgender sexual minority men and transgender women (SMMTW). Researchers have documented multiple barriers to PrEP uptake, yet the relative impacts of PrEP internalized stigma and logistical barriers (e.g., Cost; time) to PrEP use are understudied. It may be meaningful to investigate potential interactions between internalized stigma and logistical barriers to PrEP use. We utilized data from 827 Black and Hispanic/Latinx SMMTW (M_age = 25.09) in the US and found that greater PrEP-related internalized stigma and greater PrEP logistical barriers were independently significantly associated with lower likelihood of current PrEP use, but PrEP-related internalized stigma became a non-significant predictor when included in a multivariable model. We found a significant interaction between PrEP-related internalized stigma and logistical barriers to PrEP use, such that the association between internalized stigma and likelihood of current PrEP use was only significant at lower levels of logistical barriers to PrEP use. Findings highlight the need to reduce logistical barriers to PrEP use, and for clinicians to acknowledge the role of stigma for individuals who otherwise do not report logistical barriers.

KEYWORDS:

• PrEP
• stigma
• internalized stigma
• barriers
• HIV prevention
• sexual minority
• transgender

Acknowledgments

The authors thank study participants for their time.

Disclosure statement

No potential conflict of interests were reported by the authors.

Declaration of interest statement

The authors declare no conflicts or special interests.

Authors’ contributions

RW and LE designed the study, collected all data, and contributed to writing the manuscript. CC conducted data analyses and interpretation and wrote portions of the manuscript. RM, BF, and AC wrote portions of the introduction and discussion. All authors edited and critically reviewed the manuscript.

Ethics and consent to participate

This study was reviewed and approved by the Institutional Review board of the University of Connecticut.

Availability of data and materials

Data collection is ongoing and data will not currently be shared.

Additional information

Funding

This work was supported by the National Institutes of Health under Grants [R34MH115798, R01MH109409, R01DA053168, K01DA047918, K08DA045575]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.