Differences in Medical Mistrust Between Black and White Women: Implications for Patient-Provider Communication About PrEP

Abstract

Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention method. PrEP uptake has been persistently low among US women, particularly Black women, who account for 61% of new HIV diagnoses among women. Further understanding of barriers to Black women accessing PrEP is needed. This 2017 cross-sectional survey study explored race-based differences in PrEP interest and intention among women and the indirect association between race and comfort discussing PrEP with a healthcare provider through medical mistrust. The sample consisted of 501 adult women (241 Black; 260 White) who were HIV-negative, PrEP-inexperienced, and heterosexually active. Black women reported greater PrEP interest and intention than White women. However, Black women expressed higher levels of medical mistrust, which, in turn, was associated with lower comfort discussing PrEP with a provider. Medical mistrust may operate as a unique barrier to PrEP access among Black women who are interested in and could benefit from PrEP.

Keywords: Black/African American; HIV/AIDS; Medical mistrust; Pre-exposure prophylaxis (PrEP); Women.

Conflict of interest statement

Compliance with Ethical Standards

Conflicts of Interest: S. K. Calabrese has received compensation for her efforts in developing and delivering PrEP education materials. S. Hull receives honoraria for serving on PrEP for Women Steering Committee for Gilead and subcontracts on a Gilead funded research study. The authors do not have other conflicts of interest to disclose.

Figures

Figure 1.

Models of the indirect effect of race on comfort discussing PrEP with a provider through medical mistrust; a unadjusted and b adjusted for age, ethnicity, insurance status, marital status, prior PrEP knowledge, annual income, employment status, level of education, and perceived lifetime risk of HIV. In both unadjusted and adjusted models, there was a significant indirect relationship between race and comfort discussing PrEP with a healthcare provider; unadjusted model: − 0.137, SE = 0.037, 95% CI [− 0.233, − 0.061]; adjusted model: − 0.163, SE = 0.051, 95% CI [− 0.273, − 0.072]