Shared decision making for HIV pre-exposure prophylaxis (PrEP) with black transgender women

Abstract

Shared decision making is a collaborative process intended to develop a treatment plan that considers both the patient’s preferences and the health provider’s medical recommendations. It is one approach to reducing healthcare disparities by improving patient-provider communication and subsequent health outcomes. This study examines shared decision making about HIV pre-exposure prophylaxis (PrEP) with Black transgender women in Chicago, Illinois, USA, given high prevalence of HIV and disparities in PrEP use. Black transgender women were recruited online and in-person to participate in semi-structured interviews (n = 24) and focus groups (2; n = 14 total), conducted between 2016 and 2017. Iterative thematic content analysis took place. Analysis revealed that internalised transphobia and racism, combined with stigma from service providers, prevented disclosure of gender and sexual identity to providers. Stigma about PrEP as it relates to Black transgender women results in stereotype threat, which undermines patient-provider trust and deters shared decision making for PrEP. Shared decision making promotes cultural competence and humility and builds trust within the patient-provider relationship, leading to better communication and less stigma. The involvement of peers may be one way to mitigate stigma for Black transgender women around PrEP, promote cultural competence within organisations, and empower engagement in shared decision making for HIV prevention.

Keywords:

• Shared decision making
• intersectionality
• HIV pre-exposure prophylaxis
• transgender women
• racial/ethnic minority

Acknowledgements

We thank Your Voice! Your Health! participants for their contribution to this study. We acknowledge Devin Niecy for contributions on transgender health. Morten Group recruited and interviewed participants. We thank members of the Your Voice! Your Health! Study team, particularly those who provided feedback on this manuscript and the principal investigator, Marshall Chin.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This project was supported by the US Agency for Healthcare Research and Quality (U18 HS023050). John Schneider was supported by the US National Institutes of Health (R01 DA039934). Moira McNulty was supported by the Third Coast Center for AIDS Research (P30 AI 117943), the Center for Prevention Implementation Methodology (P30 DA027828) and the National Institute of Mental Health (K23 MH118969).