“Let’s take that [stop sign] down.” Provider perspectives on barriers to and opportunities for PrEP prescription to African American girls and young women in Alabama

ABSTRACT

HIV disproportionately impacts many groups, including Black adolescent girls and young women (AGYW) aged 13–24 living in the Deep South. Current prevention efforts have the potential to further exacerbate disparities within this population as HIV pre-exposure prophylaxis (PrEP) remains underutilized by Black AGYW in the South. We conducted in-depth interviews (IDIs) grounded in Andersen’s Model of Healthcare Utilization exploring providers’ PrEP prescribing practices to Black AGYW in Alabama. Eleven providers completed IDIs exploring providers’ PrEP prescription knowledge and experiences. Cross-cutting themes included: (1) Community and provider-level stigmas (including those propagated by legislation) relating to HIV and sexuality limit sexual health discussions with Black AGYW clients; (2) Low PrEP knowledge and comfort with guidelines limits PrEP conversations and reinforces low uptake and prescriptions; (3) Healthcare systems and structural barriers impede PrEP access for youth. Multi-level (structural, community, and provider) barriers to PrEP prescription demands high activation energy for providers to prescribe PrEP. We present recommendations in training in sexual health assessment, updates to PrEP guidelines to accommodate risk assessment appropriate for AGYW, and increased implementation science focused on PrEP prescription for Black AGYW in order to reduce HIV incidence for this population.

KEYWORDS:

• HIV prevention
• PrEP
• heterosexual women
• adolescents

Acknowledgements

The authors would like to acknowledge the individuals who participated in this study. We are grateful for the support of Dr. Scott Batey and Mr. Edward Jackson from the UAB Centers for AIDS Research (CFAR) Community Engaged Working Group and Drs. Michael Mugavero and Michael Saag from the UAB CFAR, who supported participant recruitment. We would also like to thank Drs. Douglas Krakower and Christina Psaros for sharing questionnaire and interview guide items.

Disclosure statement

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

Data availability statement

The data that support the findings of this study are available from the corresponding author, SVH, upon reasonable request.

Additional information

Funding

This work was supported by the National Institute of Allergy and Infectious Diseases under Grant P30AI027767.