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HIV Pre-Exposure Prophylaxis Stigma as a Multidimensional Barrier to Uptake Among Women Who Attend Planned Parenthood

Calabrese, Sarah K., PhD*,†,‡; Dovidio, John F., PhD†,‡,§; Tekeste, Mehrit, BA*; Taggart, Tamara, PhD, MPH†,‡; Galvao, Rachel W., BA; Safon, Cara B., MPH; Willie, Tiara C., MA†,‡; Caldwell, Abigail, MSN/APRN; Kaplan, Clair, MSN/APRN, MHS; Kershaw, Trace S., PhD†,‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: September 1, 2018 - Volume 79 - Issue 1 - p 46–53
doi: 10.1097/QAI.0000000000001762
Prevention Research
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Background: Pre-exposure prophylaxis (PrEP) uptake has lagged among US women. PrEP stigma is a recognized barrier to uptake among men who have sex with men but remains largely unexplored among women. This study examined the pervasiveness of PrEP stigma among US women and its implications for uptake.

Setting/Methods: In a 2017 online survey of Planned Parenthood patients drawn from the 3 cities with the highest numbers of new HIV infections in Connecticut, 597 heterosexually active, HIV-negative, PrEP-inexperienced women reported background characteristics, 2 dimensions of anticipated PrEP stigma (PrEP-user stereotypes and PrEP disapproval by others), and 3 indicators of potential PrEP uptake (interest in learning more about PrEP, intention to use PrEP, and comfort discussing PrEP with a provider).

Results: Participants commonly perceived PrEP-user stereotypes, with many believing that others would regard them as promiscuous (37%), HIV-positive (32%), bad (14%), or gay (11%) if they used PrEP. Thirty percent would feel ashamed to disclose PrEP use. Many participants expected disapproval by family (36%), sex partners (34%), and friends (25%). In adjusted analyses, perception of PrEP-user stereotypes was uniquely associated with less comfort discussing PrEP with a provider. Expected PrEP disapproval by others was uniquely associated with less PrEP interest, less intention to use PrEP, and less comfort discussing PrEP with a provider. Exploratory moderation analyses suggested that intention to use PrEP was greatest when participants anticipated low levels of both PrEP-user stereotypes and PrEP disapproval by others.

Conclusions: Findings highlight the need for positive messaging targeting potential PrEP users and their social networks to increase PrEP acceptance and uptake.

*Department of Psychology, George Washington University, Washington, DC;

Social and Behavioral Sciences Department, Yale School of Public Health, Yale University, New Haven, CT;

Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT;

§Department of Psychology, Yale University, New Haven, CT; and

Planned Parenthood of Southern New England, New Haven, CT.

Correspondence to: Sarah K. Calabrese, PhD, Department of Psychology, George Washington University, 2125 G Street NW, Washington, DC 20052 (e-mail: skcalabrese@gwu.edu).

Supported by the Yale University Center for Interdisciplinary Research on AIDS and the National Institute of Mental Health (NIMH) via Award Number P30-MH062294. S.K.C. was supported by the NIMH via Award Number K01-MH103080. T.T. was supported by the NIMH and the National Institute on Drug Abuse (NIDA) via Award Numbers T32-MH020031 and R25-DA035692, respectively. T.C.W. was supported by the NIMH via Award Numbers F31-MH113508 and R25-MH083620. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH, NIDA, National Institutes of Health (NIH), or Planned Parenthood Federation of America, Inc.

Presented in part at the 12th International Conference on HIV Treatment and Prevention Adherence; June 4, 2017; Miami, FL and the Center for AIDS Research Social and Behavioral Sciences Research Network 2017 Annual Meeting; October 24, 2017; San Francisco, CA.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.jaids.com).

Received March 07, 2018

Accepted May 09, 2018

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