Providers PrEP: Identifying Primary Health care Providers' Biases as Barriers to Provision of Equitable PrEP Services.
Providers PrEP: Identifying Primary Health care Providers' Biases as Barriers to Provision of Equitable PrEP Services.
- 2021
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.
English
1525-4135
*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 Questionnaires
MedStar Health Research Institute
Journal Article
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.
English
1525-4135
*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 Questionnaires
MedStar Health Research Institute
Journal Article