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Experimental Investigation of Implicit HIV and Preexposure Prophylaxis Stigma: Evidence for Ancillary Benefits of Preexposure Prophylaxis Use

Golub, Sarit, A., PhD, MPH*,†; Lelutiu-Weinberger, Corina, PhD†,‡; Surace, Anthony, MA†,§

JAIDS Journal of Acquired Immune Deficiency Syndromes: March 1, 2018 - Volume 77 - Issue 3 - p 264–271
doi: 10.1097/QAI.0000000000001592
Prevention Research

Background: Preexposure prophylaxis (PrEP) stigma (ie, negative attitudes toward PrEP users) has been widely documented and is considered a significant barrier to implementation. However, few studies have examined PrEP stigma using implicit measures designed to reduce demand characteristics in responding. This study examined implicit PrEP- and HIV-related stigma among gay and bisexual men using geospatial social networking applications (ie, “hookup apps”).

Methods: Participants were presented with 4 simulated online profiles (pretested for comparability) paired with each of the following characteristics: HIV negative, HIV positive, on PrEP, or substance user. Participants rated the profiles on attractiveness, desirability, trustworthiness, likelihood of condom use, and riskiness of sex.

Results: There was no evidence of PrEP-related stigma, ie, participants did not rate profiles of PrEP users more negatively than profiles of HIV-negative individuals not disclosing PrEP use. However, profiles of HIV-positive individuals were rated significantly less attractive and desirable than HIV-negative or PrEP profiles. When the sample was split by history of PrEP use, negative ratings of HIV-positive profiles remained only among participants who had never taken PrEP. Participants with any history of PrEP use demonstrated no difference in ratings by HIV status.

Conclusion: These data provide the first empirical evidence for lower HIV stigma among PrEP users. Individuals who have used PrEP may “see” HIV-positive individuals differently than those without a history of PrEP use. The lack of evidence for PrEP-related stigma is encouraging and suggests that negative stereotypes about PrEP users may not extend to negative implicit judgments about them on social networking sites.

*Department of Psychology, Hunter College and the Graduate Center of the City University of New York, New York, NY;

Department of Psychology, Hunter HIV/AIDS Research Team (HART), New York, NY;

Department of Psychology, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, NJ; and

§Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI.

Correspondence to: Sarit A. Golub, PhD, MPH, Department of Psychology, Hunter HIV/AIDS Research Team (HART), Hunter College and Graduate Center of the City University of New York (CUNY), 695 Park Avenue, New York, NY 10065 (e-mail: sgolub@hunter.cuny.edu).

S.G. is funded by NIH (R01AA022077; R01MH105268), and has received study drug from Gilead Sciences for use in an NIH-funded PrEP demonstration project. C.L.W. is funded by NIH (R21MH113860). The remaining authors have no funding or conflicts of interest to disclose.

Received July 24, 2017

Accepted October 27, 2017

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