Stigma, Partners, Providers and Costs: Potential Barriers to PrEP Uptake among US Women

Lakshmi Goparaju, Nathan C Praschan, Lari Warren-Jeanpiere, Laure S Experton, Mary A Young, Seble Kassaye, Lakshmi Goparaju, Nathan C Praschan, Lari Warren-Jeanpiere, Laure S Experton, Mary A Young, Seble Kassaye

Abstract

Background: Pre-Exposure Prophylaxis (PrEP) use has remained low among US women while significantly increasing among men who have sex with men. Besides lack of awareness, women face several social and structural barriers in gaining access to and using PrEP.

Methods: Four focus group discussions with 20 HIV-negative women who live in the Washington DC metropolitan area.

Results: The women expressed concerns about social and structural barriers to PrEP use. They were afraid that stigma related to using "HIV medicines" could affect PrEP use as well. They are worried that family and friends may question their reasons for taking anti-retrovirals and suspect that they were HIV-positive. They expected hostile reactions from male partners, including accusations of infidelity and introducing mistrust in their relationships. Communicating with health care providers about sexual matters in general and their need for PrEP in particular were identified as further barriers. Women reported that providers rarely ask about risk behaviors related to HIV acquisition; that short visits hinder establishing a trusting relationship to discuss sensitive matters. They were concerned that disclosure of risk behaviors may result in judgmental responses and harsh treatment from providers. Lastly, women were concerned that PrEP costs, including insurance coverage and copays, would keep PrEP out of their reach. While cognizant of the potential barriers, women were unwavering in their determination to find ways to circumvent challenges to PrEP access.

Conclusion: Social and structural barriers may impede women's access to PrEP despite their own reported interest. Continued efforts to reduce HIV stigma, improve patient-provider relationships and ensure affordability of PrEP may increase the likelihood that women will use this important prevention modality.

Keywords: HIV Prevention; Pre-exposure prophylaxis; Women.

References

    1. Centers for Disease Control and Prevention. Interim guidance: Pre-exposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR Morb Mortal Wkly Rep. 2011;60:65–68.
    1. Centers for Disease Control and Prevention. Interim guidance for clinicians considering the use of preexposure prophylaxis for the prevention of HIV infection in heterosexually active adults. MMWR Morb Mortal Wkly Rep. 2011;61:586–589.
    1. Food and Drug Administration, editor. Food and Drug Administration. FDA approves first drug for reducing the risk of prophylaxis for HIV prevention in heterosexual men and women. 2012.
    1. Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367:399–410.
    1. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363:2587–2599.
    1. Volk JE, Marcus JK, Phengrasamy T, Blechinger D, Nguyen DP, et al. No new HIV infections with increasing use of HIV pre-exposure prophylaxis in a clinical practice setting. Clin Infect Dis. 2015;61:1601–1613.
    1. Centers for Disease Control and Prevention. CDC. 2016. HIV among women.
    1. Bush S. Presentation of the American Society for Microbiology. 2016. Racial characteristics of FTC/TDF for pre-exposure prophylaxis users in the U.S.
    1. Jayakumaran JS, Aaron E, Gracely EJ, Schriver E, Szep Z, et al. Knowledge, attitudes and acceptability of pre-exposure prophylaxis among individuals living with HIV in an urban HIV clinic. PLoS ONE. 2016;11:1–10.
    1. Goparaju L, Experton LS, Praschan NC, Warren-Jeanpiere L, Young MA, et al. Women want pre-exposure prophylaxis but are advised against it by their HIV-positive counterparts. J AIDS Clin Res. 2015;6:1–10.
    1. Auerbach JD, Kinsky S, Brown G, Charles V. Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV. AIDS Patient Care STDS. 2015;29:102–110.
    1. Marrazzo JM, Ramjee G, Richardson BA, Gomez K, et al. Tenofovir-based pre-exposure prophylaxis for HIV infection among African women. N Engl J Med. 2015;372:509–518.
    1. Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367:411–422.
    1. Corneli AL, Deese J, Wang M, Taylor D, Ahmed K, et al. FEM-PrEP: Adherence patterns and factors associated with adherence to a daily oral study product for pre-exposure prophylaxis. J Acquir Immune Defc Syndr. 2014;66:324–331.
    1. Patterson KB, Prince HA, Kraft E, Jenkins AJ, Shaheen NJ, et al. Penetration of tenofovir and emtricitabine in mucosal tissues: Implications for prevention of HIV-1 transmission. Sci Transl Med. 2011;3:1–8.
    1. van der Straten A, Mayo A, Brown ER, Rivet Amico K, Cheng H, et al. Perceptions and experiences with the VOICE adherence strengthening program (VASP) in the MTN-003 trial. AIDS Behav. 2015;19:770–783.
    1. van der Straten A, Stadler J, Luecke E, Laborde N, Hartmann M, et al. Perspectives on use of oral and vaginal antiretrovirals for HIV prevention: The VOICE-C qualitative study in Johannesburg, South Africa. J Int AIDS Soc. 2014;7:1–7.
    1. Eisingerich AB, Wheelock A, Gomez GB, Garnett GP, Dybul MR, et al. Attitudes and acceptance of oral and parenteral HIV pre-exposure prophylaxis among potential user groups: A multinational study. PLoS ONE. 2012;7:1–11.
    1. Smith DK, Toledo L, Smith DJ, Adams MA, Rothenberg R, et al. Attitudes and program preferences of African-American urban young adults about pre-exposure prophylaxis (PrEP) AIDS Educ Prev. 2012;24:408–421.
    1. Young I, McDaid L. How acceptable are antiretrovirals for the prevention of sexually transmitted HIV? A review of research on the acceptability of oral pre-exposure prophylaxis and treatment as prevention. AIDS Behav. 2014;18:195–216.
    1. Roberts ET, Matthews DD. HIV and chemoprophylaxis, the importance of considering social structures alongside biomedical and behavioral intervention. Soc Sci Med. 2012;75:1555–1561.
    1. Cowan FM, Delany-Moretlwe S. Promise and pitfalls of pre-exposure prophylaxis for female sex workers. Curr Opin HIV AIDS. 2016;11:27–34.
    1. Ware NC, Wyatt MA, Haberer JE, Baeten JM, Kintu A, et al. What's love got to do with it? Explaining adherence to oral antiretroviral pre-exposure prophylaxis for HIV-serodiscordant couples. J Acquir Immune Defic Syndr. 2012;59:463–468.
    1. Brody LR, Jack DC, Bruck-Segal DL, Ruffing EG, Firpo-Perretti YM, et al. Life lessons from women with HIV: Mutuality, self-awareness and self-efficacy. AIDS Patient Care STDS. 2016;30:261–73.
    1. Bacon MC, Wyl VV, Alden C, Sharp G, Robison E, et al. The Women's interagency HIV study: An observational cohort brings clinical sciences to the bench. Clin Diagn Lab Immunol. 2005;12:1013–1019.
    1. Centers for Disease Control and Prevention, editor. US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States, in a clinical practice guideline. 2014.
    1. Centers for Disease Control and Prevention. Basic information on PrEP: Fact sheet 2015
    1. Mahajan AP, Sayles JN, Patel VA, Remien RH, Ortiz D, et al. Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward. AIDS. 2008;22:67–79.
    1. Vanable PA, Carey MP, Blair DC, Littlewood RA. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav. 2006;10:473–482.
    1. Montgomery ET, Straten AV, Chidanyika A, Chipato T, Jaffar S, et al. The importance of male partner involvement for women's acceptability and adherence to female-initiated HIV prevention methods in Zimbabwe. AIDS Behav. 2011;15:959–969.
    1. Braksmajer A, Senn TE, McMahon J. The Potential of pre-exposure prophylaxis for women in violent relationships. AIDS Patient Care STDS. 2016;30:274–281.
    1. Brothers J, Hotton AL, Hosek SG, Harper GW, Fernandez I. Young women living with HIV: Outcomes from a targeted secondary prevention empowerment pilot trial. AIDS Patient Care STDS. 2016;30:229–235.
    1. Loeb DF, Lee RS, Binswanger IA, Ellison MC, Aagaard EM. Patient, resident physician and visit factors associated with documentation of sexual history in the outpatient setting. J Gen Intern Med. 2011;26:887–893.
    1. Wimberly YH, Hogben M, Moore-Ruffin J, Moore SE, Fry-Johnson Y. Sexual history-taking among primary care physicians. J Natl Med Assoc. 2006;98:1924–1929.
    1. Lanier Y, Castellanos T, Barrow RY, Jordan WC, Caine V, et al. Brief sexual histories and routine HIV/STD testing by medical providers. AIDS Patient Care STDS. 2014;28:113–120.
    1. Flickinger TE, Berry S, Korthuis PT, Saha S, Laws MB, et al. Counseling to reduce high-risk sexual behavior in HIV care: A multi-center, direct observation study. AIDS Patient Care STDS. 2013;27:416–424.
    1. Ngure K, Heffron R, Curran K, Vusha S, et al. I knew i would be safer. Experiences of Kenyan HIV serodiscordant couples soon after pre-exposure prophylaxis (PrEP) initiation. AIDS Patient Care STDS. 2016;30:78–83.
    1. Muessig KE, Panter AT, Mouw MS, Amola K, et al. Medication-taking practices of patients on antiretroviral HIV therapy: Control, power and intentionality. AIDS Patient Care STDS. 2015;29:606–616.
    1. Rubtsova A, Wingoof GM, Dunkle K, Camp C, DiClemente RJ. Young adult women and correlates of potential adoption of pre-exposure prophylaxis (PrEP): Results of a national survey. Curr HIV Res. 2013;11:543–548.
    1. Finocchario-Kessler S, Champassak S, Hoyt MJ, Short W, Rana C, et al. Pre-exposure prophylaxis (PrEP) for safer conception among serodifferent couples: Findings from healthcare providers serving patients with HIV in seven US cities. AIDS Patient Care STDS. 2016;30:125–133.

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