Study Identifies Barriers to PrEP Uptake in Black Female Adolescents, Young Adults

Pre-exposure prophylaxis (PrEP) significantly reduces the risk of HIV infection, but concerns about adverse effects (AEs), financial factors, and medical mistrust surrounding PrEP may limit its uptake in Black female adolescents and emerging adults (AEA), a recent study suggests.

HIV disproportionately impacts Black communities in the United States, with past research suggesting that individual and structural barriers impact PrEP uptake despite evidence supporting its efficacy. The study, published in Preventive Medicine Reports, specifically aimed to characterize the intersectional life experiences affecting PrEP uptake in Black cisgender female AEAs.

Between January 2019 and June 2019, a total of 100 Black female AEAs aged 13 to 24 years completed a survey distributed in waiting rooms at 2 women’s health clinics in Chicago. More than half (53%) of respondents were aware of PrEP, and 8% reported feeling that there was a probable likelihood of them contracting or transmitting HIV.

The most commonly reported barriers to uptake were concerns about the possible AEs of PrEP, financial concerns, and medical mistrust. Safety and potential AEs worried 39% of respondents, who reported fevers, vomiting, and pregnancy complications as top concerns. Social media and television were main sources of information on AEs.

“Among participants, misconception and insufficient knowledge about PrEP side effects intersected with, and in some cases, was further fueled by medical mistrust,” the authors wrote.

Appropriate educational initiatives to provide evidence-based information on the safety and efficacy of PrEP could help address this barrier. Financial concerns, including out-of-pocket costs for uninsured individuals, were cited by 15% of respondents.

A lack of insurance also often intersects with unemployment, the authors noted, which presents 2 barriers in 1 for women in this situation. Medical mistrust was cited as a barrier to PrEP uptake by 12% of respondents.

The perceived newness of the drug, general mistrust of the medical community, and other intersecting themes were cited by respondents.

“Medical mistrust as a theme informing barriers to care among those within the Black community is not new,” the authors wrote. “Medical mistrust predates PrEP. Generations of strong Black women pass down cautionary tales detailing evidence of medical racism.”

Culturally safe interventions are crucial to overcome this barrier, and providers must aim to both understand the experiences of Black female AEAs and self-reflect on their own potential biases.

A lack of PrEP knowledge and misconceptions about PrEP, the stigma associated with it, and privacy concerns were also cited as reasons for hesitancy when it comes to PrEP. Women covered by parental insurance reported being worried about their parents finding out that they were on PrEP.

One respondent voiced concern that she would not be guaranteed patient-provider confidentiality under parental insurance. To overcome the issue of stigma and misconceptions, fostering discussions about the evidence supporting PrEP with patients as well as their communities is a key potential intervention.

The findings provide insight into barriers to uptake of PrEP among Black female AEAs, as well as provide starting points for strategies to improve uptake. Overall, interventions in this community need to address intersecting factors, including medical mistrust and historical oppression, to raise awareness of the benefits of PrEP and increase its uptake in Black female AEAs.

“Our findings suggest educational and delivery strategies need to be age-appropriate and tailored to the needs of Black AEA that explain the value of PrEP,” the authors wrote. “Additionally, the influence of sexual partners, reproductive coercion, and intimate partner violence should be further explored as barriers to PrEP uptake. These factors intersect with HIV vulnerability among Black girls and women.”

Reference

Crooks N, Singer RB, Smith A, et al. Barriers to PrEP uptake among Black female adolescents and emerging adults. Prev Med Rep. 2022;31:102062. Published online November 24, 2022. doi:10.1016/j.pmedr.2022.102062.