Providers PrEP: Identifying Primary Health care Providers' Biases as Barriers to Provision of Equitable PrEP Services.

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Citation: Journal of Acquired Immune Deficiency Syndromes: JAIDS. 88(2):165-172, 2021 10 01.PMID: 34506359Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Anti-HIV Agents/ad [Administration & Dosage] | *Attitude of Health Personnel | *Drug Prescriptions/sn [Statistics & Numerical Data] | *Health Personnel/px [Psychology] | *Healthcare Disparities | *HIV Infections/pc [Prevention & Control] | *Pre-Exposure Prophylaxis/mt [Methods] | Adult | Anti-HIV Agents/tu [Therapeutic Use] | Bias | Female | Health Care Surveys | Health Knowledge, Attitudes, Practice | Health Services Accessibility | HIV Infections/eh [Ethnology] | HIV Infections/px [Psychology] | Homosexuality, Male | Humans | Male | Pre-Exposure Prophylaxis/sn [Statistics & Numerical Data] | Prejudice | Primary Health Care | Racism | Socioeconomic Factors | Surveys and QuestionnairesYear: 2021ISSN:
  • 1525-4135
Name of journal: Journal of acquired immune deficiency syndromes (1999)Abstract: BACKGROUND: Despite their disparately high HIV incidence and voiced willingness to use pre-exposure prophylaxis (PrEP), Black cisgender women's knowledge and uptake of PrEP are low, especially relative to White cisgender women and men who have sex with men. Mounting evidence demonstrates that health care provider recommendations are a critical factor in women's awareness, willingness, and ability to uptake PrEP. Health care providers may make clinical judgments about who is (not) a good candidate for PrEP based on unconscious and conscious stereotypes and prejudice.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. Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved.METHOD: Providers received 1 of 4 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 to prescribe PrEP to her.RESULTS: We tested 2 models predicting providers (1) willingness to discuss and (2) 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.SETTING: We conducted an online experiment among N = 160 health care providers with prescribing privileges in the 48 HIV hotspot counties.All authors: Hull SJ, Scott RK, Tessema H, Thuku JOriginally published: Journal of Acquired Immune Deficiency Syndromes: JAIDS. 88(2):165-172, 2021 Oct 01.Fiscal year: FY2022Fiscal year of original publication: FY2022Digital Object Identifier: Date added to catalog: 2021-11-01
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Journal Article MedStar Authors Catalog Article 34506359 Available 34506359

BACKGROUND: Despite their disparately high HIV incidence and voiced willingness to use pre-exposure prophylaxis (PrEP), Black cisgender women's knowledge and uptake of PrEP are low, especially relative to White cisgender women and men who have sex with men. Mounting evidence demonstrates that health care provider recommendations are a critical factor in women's awareness, willingness, and ability to uptake PrEP. Health care providers may make clinical judgments about who is (not) a good candidate for PrEP based on unconscious and conscious stereotypes and prejudice.

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. Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved.

METHOD: Providers received 1 of 4 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 to prescribe PrEP to her.

RESULTS: We tested 2 models predicting providers (1) willingness to discuss and (2) 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.

SETTING: We conducted an online experiment among N = 160 health care providers with prescribing privileges in the 48 HIV hotspot counties.

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