Structural and syndemic barriers to PrEP adoption among Black women at high risk for HIV: a qualitative exploration

Abstract

In the USA, Black women are at disproportionately higher risk for HIV compared to women of other races/ethnicities, which can be explained by the Substance Abuse, Violence and AIDS (SAVA) syndemic. Disparities in HIV, substance use and violence are driven by multiple influences, including structural factors (e.g. housing and poverty), which exacerbate social- and individual-level factors leading to more sex partners, engaging in unprotected sex, having sex for money, experiencing forced sex from an intimate partner or increased substance use, all of which increase HIV risk. Pre-exposure prophylaxis (PrEP), a pill that can prevent HIV, is a discreet and underutilised method that Black women experiencing syndemics can use to decrease their risk. This study explored Black women’s interest in, and barriers to adopting PrEP over 6 months. Thirty Black women (age M = 32.2) who experienced multiple substance use, violence and HIV-related syndemic factors were interviewed four times over a 6-month period. Results demonstrated that experiencing intimate partner violence, substance use, community violence and other structural factors (poor access to social services, transport and childcare) all acted as barriers to PrEP adoption. Future research should consider multi-level interventions that include methods such as media campaigns, providing PrEP or referrals where women who experience syndemic and structural factors seek help, and implement a PrEP adherence programmes and interventions in support group settings.

Keywords:

• Black/African American women
• pre-exposure prophylaxis adoption
• SAVA syndemic
• housing instability
• HIV

Acknowledgements

The authors acknowledge the participants who shared their stories. They also thank the project staff and students who dedicated their time to the study and specifically Heran Kidane for her insightful feedback and editing.

Disclosure statement

The authors have no conflict of interest to disclose.

Data access

Data is available in the Texas Data Repository: https://doi.org/10.18738/T8/6WJIXG

Notes

1 Participants were provided the option to sign a form to waive the Health Insurance Portability and Accountability Act granting permission to the clinic to disclose their protected health information to the research team for research purposes only and only for the duration of their participation in the study. They could cancel or revoke their authorisation at any time.

Additional information

Funding

This work was supported by the US National Institute of Mental Health under Grant P30 MH52776; the US National Institute of Mental Health under Grant under Grant T32 0MH19985; and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development under Grant P2CHD042849.