\u201cPrEP\u2019s just to secure you like insurance\u201d: a qualitative study on HIV pre-exposure prophylaxis (PrEP) adherence and retention among black cisgender women in Mississippi

Tiara C Willie,Adaora A Adimora,Stefan D Baral,Deja Knight,Karlye A Philllips,Amy Nunn,Mauda Monger,Trace Kershaw,Philip A Chan,Leandro A Mena,Kenneth H Mayer,Jamila K Stockman

doi:10.1186/s12879-021-06786-1

Abstract

BackgroundPre-exposure prophylaxis (PrEP) has the potential to reduce transmission of HIV among Black cisgender women in the Southern United States (U.S.); however, national data suggests that PrEP initiation is lowest in the South and among Black women compared to other U.S. regions and white women. This study applied intersectionality and PrEP multilevel resilience frameworks to assess how socio-structural and clinical contexts shaped PrEP persistence among Black cisgender women in Mississippi.MethodsSemi-structured interviews were conducted with eight Black cisgender women in Jackson, Mississippi. This sample was purposively recruited to include PrEP-initiated Black cisgender women.ResultsSix themes identified that shaped PrEP care among Black cisgender women: (1) internal assets, (2) sole responsibility to HIV prevention, (3) added protection in HIV serodifferent relationships, (4) financial issues, (5) trust and distrust in the medical system, and (6) side effects. Black cisgender women reported that PrEP persistence increased control over their sexual health, reduced anxiety about HIV, and promoted self-care. Black cisgender women also indicated that medication assistance programs increased PrEP affordability resulting in continued persistence.ConclusionsIn addition to preventing HIV, PrEP may yield secondary positive impacts on the health and relationships of Black cisgender women. However, very few Black cisgender women in the South are using PrEP given intersectional barriers and thus necessitates adaptive strategies to support PrEP initiation and persistence. Efforts aimed at increasing the coverage of PrEP among Black cisgender women should consider implementation strategies responsive to lived realities of Black women.

Highlights

Pre-exposure prophylaxis (PrEP) has the potential to reduce transmission of Human Immuno-Deficiency Virus (HIV) among Black cisgender women in the Southern United States (U.S.); national data suggests that PrEP initiation is lowest in the South and among Black women compared to other U.S regions and white women
Factors related to the health system are important to address, and our study extends current research by describing how the socio-structural context further complicates experiences of PrEP persistence among Black cisgender women
Black women across the South continue to be disproportionately affected by HIV highlighting unmet needs

Summary

Introduction

Pre-exposure prophylaxis (PrEP) has the potential to reduce transmission of HIV among Black cisgender women in the Southern United States (U.S.); national data suggests that PrEP initiation is lowest in the South and among Black women compared to other U.S regions and white women. Across the U.S, the South has the highest rates of HIV diagnoses, and Black women account for more than two-thirds of HIV diagnoses among women [3]. These geographic and racial disparities in HIV infection helped inform the U.S Plan for Ending the HIV Epidemic (EHE). Among women in Mississippi, Black women represented 86% of all new infections and were nine times more likely to acquire HIV than white women [6]. Enhancing uptake of evidence-based HIV prevention strategies to reduce heterosexual transmission of HIV among Black women, women in the South, is critical

Objectives

Methods

Results

Discussion

Conclusion