Barriers and Facilitators to Pre-exposure Prophylaxis Uptake Among Black Women: A Qualitative Analysis Guided by a Socioecological Model

Alexa B D'Angelo; Leah N Davis Ewart; Juline Koken; David Bimbi; Justin T Brown; Christian Grov

doi:10.1097/JNC.0000000000000241

Barriers and Facilitators to Pre-exposure Prophylaxis Uptake Among Black Women: A Qualitative Analysis Guided by a Socioecological Model

J Assoc Nurses AIDS Care. 2021 Jul-Aug;32(4):481-494. doi: 10.1097/JNC.0000000000000241.

Authors

Alexa B D'Angelo¹, Leah N Davis Ewart, Juline Koken, David Bimbi, Justin T Brown, Christian Grov

Affiliation

¹ Alexa B. D'Angelo, MPH, is a Project Coordinator and PhD Student, CUNY Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, New York, New York, USA. Leah N. Davis Ewart, MPH, CHES, is a PhD Student, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA. Juline Koken, PhD, is an Associate Professor, Department of Health Sciences, LaGuardia Community College of CUNY, Long Island City, New York, USA. David Bimbi, PhD, is a Professor, Department of Health Sciences, LaGuardia Community College of CUNY, Long Island City, New York, USA. Justin T. Brown, PhD, MPH, is an Assistant Professor and Executive Director, Department of Health Sciences, The Center for LGBTQ Studies (CLAGS), LaGuardia Community College of CUNY, Long Island City, New York, USA. Christian Grov, PhD, MPH, is a Professor, Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA.

PMID: 34171885
DOI: 10.1097/JNC.0000000000000241

Abstract

Black women experience disparities in HIV incidence. Pre-exposure prophylaxis (PrEP) is a once-daily pill that can prevent HIV transmission. To enhance PrEP uptake among Black women, it is essential to examine their perceptions of PrEP. In 2018, 33 Black women in New York City completed interviews about their attitudes, knowledge, and perceived barriers and facilitators to PrEP use. Emergent themes were organized using a socioecological model. Participants identified barriers at the sociocultural level, including stigma, medical mistrust, and health care avoidance. At the community level, health care access issues and limited community knowledge were reported. Partner-level barriers included trust in partners and meaning attributed to PrEP use within the context of monogamy. Individual-level barriers included low perceived risk and concerns about PrEP's safety and efficacy. Our findings can inform future PrEP research with Black women, as well as PrEP implementation efforts aimed at increasing uptake among this population.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-HIV Agents* / therapeutic use
Female
HIV Infections* / drug therapy
HIV Infections* / prevention & control
Health Knowledge, Attitudes, Practice
Health Services Accessibility
Humans
Pre-Exposure Prophylaxis*
Trust

Substances

Anti-HIV Agents