The impact of patient race on clinical decisions related to prescribing HIV pre-exposure prophylaxis (PrEP): assumptions about sexual risk compensation and implications for access

AIDS Behav. 2014 Feb;18(2):226-40. doi: 10.1007/s10461-013-0675-x.


Antiretroviral pre-exposure prophylaxis (PrEP) has received increasing recognition as a viable prescription-based intervention for people at risk for HIV acquisition. However, little is known about racial biases affecting healthcare providers' willingness to prescribe PrEP. This investigation sought to explore medical students' stereotypes about sexual risk compensation among Black versus White men who have sex with men seeking PrEP, and the impact of such stereotypes on willingness to prescribe PrEP. An online survey presented participants (n = 102) with a clinical vignette of a PrEP-seeking, HIV-negative man with an HIV-positive male partner. Patient race was systematically manipulated. Participants reported predictions about patient sexual risk compensation, willingness to prescribe PrEP, and other clinical judgments. Bootstrapping analyses revealed that the Black patient was rated as more likely than the White patient to engage in increased unprotected sex if prescribed PrEP, which, in turn, was associated with reduced willingness to prescribe PrEP to the patient.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • African Continental Ancestry Group / statistics & numerical data
  • Anti-HIV Agents / therapeutic use
  • Antibiotic Prophylaxis*
  • Attitude of Health Personnel
  • Cultural Competency
  • Decision Making*
  • Drug Prescriptions
  • European Continental Ancestry Group / statistics & numerical data
  • HIV Infections / ethnology
  • HIV Infections / prevention & control*
  • HIV Infections / psychology
  • Health Care Surveys
  • Health Knowledge, Attitudes, Practice
  • Health Personnel / psychology*
  • Health Services Accessibility
  • Homosexuality, Male
  • Humans
  • Male
  • Prejudice
  • Racism*
  • Socioeconomic Factors
  • Students, Medical / psychology*
  • Surveys and Questionnaires


  • Anti-HIV Agents