Considering Stigma in the Provision of HIV Pre-Exposure Prophylaxis: Reflections from Current Prescribers.
AIDS Patient Care STDS
; 33(2): 79-88, 2019 02.
Article
in En
| MEDLINE
| ID: mdl-30715918
ABSTRACT
Efforts to identify and address social inequities in HIV pre-exposure prophylaxis (PrEP) access are urgently needed. We investigated early-adopting PrEP prescribers' beliefs about how stigma contributes to PrEP access disparities in health care and explored potential intervention strategies within the context of PrEP service delivery. US-based PrEP prescribers were recruited through professional networks and participant referrals. Qualitative interviews were conducted, transcribed, and thematically analyzed. Participants (n = 18) were primarily male (72%); white (39%) or Asian (33%); and heterosexual (56%). Most practiced in the Northeastern (67%) or Southern (22%) United States; were physicians (94%); and specialized in HIV/infectious disease (89%). Participants described multiple forms of structural and interpersonal stigma impeding PrEP access. The requirement that PrEP be prescribed was a perceived deterrent for populations with medical mistrust and/or low health literacy. Practice norms such as discussing PrEP only in response to patient requests were seen as favoring more privileged groups. When probed about personally held biases, age-related stereotypes were the most readily acknowledged, including assumptions about older adults being sexually inactive and uncomfortable discussing sex. Participants criticized providers who chose not to prescribe PrEP within their clinical practice, particularly those whose decision reflected personal values related to condomless sex or discomfort communicating about sex with their patients. Suggested solutions included standardizing PrEP service delivery across patients and increasing cultural competence training. These early insights from a select sample of early-adopting providers illuminate mechanisms through which stigma could compromise PrEP access for key populations and corresponding points of intervention within the health care system.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Drug Prescriptions
/
HIV Infections
/
Health Personnel
/
Anti-HIV Agents
/
Trust
/
Healthcare Disparities
/
Social Stigma
/
Pre-Exposure Prophylaxis
/
Health Services Accessibility
Type of study:
Prognostic_studies
/
Qualitative_research
Aspects:
Determinantes_sociais_saude
Limits:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
America do norte
Language:
En
Journal:
AIDS Patient Care STDS
Journal subject:
DOENCAS SEXUALMENTE TRANSMISSIVEIS
/
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Year:
2019
Document type:
Article