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Providers PreP: Identifying Primary Healthcare Providers' Biases as Barriers
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10 01 2021
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Source: J Acquir Immune Defic Syndr. 88(2):165-172
[PDF-489.06 KB]
Details:
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Alternative Title:J Acquir Immune Defic Syndr
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Description:Background:
Despite their disparately high HIV incidence and voiced willingness to use PrEP, Black cisgender women’s (CGW) knowledge and uptake of PrEP are low, especially relative to White CGW and men who have sex with men. Mounting evidence demonstrates that healthcare provider recommendations are a critical factor in women’s awareness, willingness and ability to uptake PrEP. Healthcare providers may make clinical judgements about who is (not) a good candidate for PrEP based on unconscious and conscious stereotypes and prejudice.
Setting:
We conducted an online experiment among N = 160 healthcare providers with prescribing privileges in the 48 HIV hotspot counties.
Method:
Providers received one of four vignettes about a PrEP eligible woman. Vignettes varied by patient race and substance use status. Then, providers reported their willingness to discuss PrEP with the patient and willingness prescribe PrEP to her.
Results:
We tested two models predicting providers a) willingness to discuss and b) willingness to prescribe PrEP, contingent on their racial attitudes. Providers who scored high on a modern racism measure were less willing to discuss and prescribe PrEP to the Black patient. These effects were mediated by provider perceptions of patients’ abilities to adhere to PrEP, but not their expectations of risk-compensatory behaviors.
Conclusions:
Our findings highlight the importance of applying an intersectional lens in documenting the processes that exacerbate inequities in PrEP use. This study provides evidence to support the development of interventions that address the mechanisms that work to thwart optimal care.
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Pubmed ID:34506359
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Pubmed Central ID:PMC8577287
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