The Influence of PreP Stigma Among Black and Latino MSM PreP Adopters

Abstract: Pre-Exposure Prophylaxis (PrEP) is a biomedical HIV prevention strategy with the potential to reduce the rate of new HIV infection among black and Latino men who have sex with men (BLMSM), two populations at the center of the U.S. HIV/AIDS epidemic. However, the social stigma currently associated with the use of PrEP (i.e. PrEP stigma) may negatively influence PrEP disclosure, diffusion, adherence and retention among BLMSM who adopt PrEP. The controversy and contention surrounding the implementation of PrEP in the gay community has led to the stigmatization of PrEP and those who use it. PrEP users may experience PrEP stigma in the form of negative perceptions (e.g., being judged, being unfairly treated), stigmatizing attributions (e.g., promiscuous, sexually irresponsible, mistakenly identified as HIV-positive), and stigmatizing practices (e.g., rejection, prejudice, discrimination) from friends, sex partners, providers and others. The goals of this study are to explore the nature and extent of PrEP stigma among BLMSM who have adopted PrEP and to assess its influence on PrEP disclosure, adherence and retention, and the diffusion of PrEP information to other potential BLMSM PrEP consumers. The specific aims of this study are: 1) to examine how BLMSM PrEP adopters experience PrEP stigma (e.g., anticipated, internalized, enacted); 2) to assess the extent and context of PrEP disclosure and dissemination of PrEP information by BLMSM PrEP users to other potential BLMSM PrEP consumers; and 3) to examine the influence of PrEP stigma, over time, on adherence and retention to PrEP among BLMSM PrEP adopters. To achieve these aims, this qualitative study will involve conducing in- depth interviews with 50 black (N = 25) and Latino (N = 25) MSM PrEP adopters and 20 black (N = 10) and Latino (N = 10) MSM non-PrEP adopters. BLMSM PrEP adopters will complete both a baseline and a 6-month follow-up interview. Follow-up interviews will assess changes in PrEP retention, adherence, disclosure and dissemination. Interviews with BLMSM non-PrEP adopters will elicit information about anticipated PrEP stigma and how this may have influenced decisions to seek or not seek PrEP. Interviews will also be conducted with 20 medical providers to assess their perceptions of PrEP and PrEP stigma and concerns about the implementation of PrEP. The findings from this study will inform the development of intervention activities that seek to prevent or mitigate the negative social experiences associated with PrEP adoption and to optimize diffusion and retention to PrEP among minority MSM.

Project Number: 5R21MH107339-02