Pre Exposure Prophylaxis (PrEP) Barriers for Black Young Men who Are Sexually Active With Men in the Southern US
Henna Budhwani, Hanne S. Harbison, Angulique Y. Outlaw, Michael J. Mugavero, Mallory O. Johnson, Robert A. Oster, Lisa B. Hightow-Weidman, Sylvie Naar, Josh Bruce, Janet M. TuranObjective
To elucidate barriers and facilitators to pre-exposure prophylaxis (PrEP) by eliciting the perspectives of Black, young men who have sex with men (BYMSM) and HIV prevention and outreach staff.
Background
BYMSM are disproportionately represented in new HIV infections in the United States (US). PrEP is one of the available biomedical prevention tools that can significantly reduce HIV infections. Despite increases in uptake of PrEP among high priority key populations, PrEP use among BYMSM remains insufficient.
Methods
Qualitative data collection occurred between 2020 and 2022. We conducted in-depth interviews and focus groups with 56 BYMSM and 12 prevention and outreach staff in Alabama. Two researchers dual-coded verbatim transcripts from audio files, guided by a codebook that included inductive and deductive themes. We used NVivo qualitative software for coding and analysis.
Results
Three themes emerged from both participant groups: (1) Lack of knowledge about PrEP among BYMSM, (2) Structural barriers to accessing PrEP, and (3) Culturally or contextually specific concerns around PrEP, including HIV related stigma and fear of being treated poorly related to identity. Participants offered recommendations to increase PrEP uptake, including tailored PrEP education and using peer advocates to normalize PrEP and reach people who may not routinely interact with healthcare.
Conclusions
Our results suggest several next steps to increase PrEP uptake among BYMSM in the southern US. These include hiring and training peer advocates in the same age group as the target population, developing accessible educational materials for BYMSM, researching provider barriers to prescribing PrEP to this population, and conducting feasibility studies on using mobile clinics to provide HIV services in rural communities.