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. 2014 Feb;18(2):226-40.
doi: 10.1007/s10461-013-0675-x.

The impact of patient race on clinical decisions related to prescribing HIV pre-exposure prophylaxis (PrEP): assumptions about sexual risk compensation and implications for access

Sarah K Calabrese  1 , Valerie A Earnshaw, Kristen Underhill, Nathan B Hansen, John F Dovidio
Affiliations

The impact of patient race on clinical decisions related to prescribing HIV pre-exposure prophylaxis (PrEP): assumptions about sexual risk compensation and implications for access

Sarah K Calabrese et al. AIDS Behav. 2014 Feb.

Abstract

Antiretroviral pre-exposure prophylaxis (PrEP) has received increasing recognition as a viable prescription-based intervention for people at risk for HIV acquisition. However, little is known about racial biases affecting healthcare providers' willingness to prescribe PrEP. This investigation sought to explore medical students' stereotypes about sexual risk compensation among Black versus White men who have sex with men seeking PrEP, and the impact of such stereotypes on willingness to prescribe PrEP. An online survey presented participants (n = 102) with a clinical vignette of a PrEP-seeking, HIV-negative man with an HIV-positive male partner. Patient race was systematically manipulated. Participants reported predictions about patient sexual risk compensation, willingness to prescribe PrEP, and other clinical judgments. Bootstrapping analyses revealed that the Black patient was rated as more likely than the White patient to engage in increased unprotected sex if prescribed PrEP, which, in turn, was associated with reduced willingness to prescribe PrEP to the patient.

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Figures

Fig. 1
Fig. 1
Model of the indirect effect of patient race on participant willingness to prescribe PrEP. Unstandardized coefficients and standard errors [B (SE)] are included for all paths. Participant sociodemographic and medical training characteristics (gender, race, sexual orientation, age, social class, current year of medical school, and past clinical experience with HIV-positive patients); other clinical judgments (predicted patient adherence, perceived patient risk of HIV infection without PrEP, and risk reduction associated with PrEP); and racial bias (perceived importance of patient request and general feelings toward Black versus White patients) were statistically controlled in the analysis
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