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. 2022 Nov;34(11):1473-1480.
doi: 10.1080/09540121.2022.2105799. Epub 2022 Aug 1.

"Let's take that [stop sign] down." Provider perspectives on barriers to and opportunities for PrEP prescription to African American girls and young women in Alabama

Samantha V Hill  1 , M C Pratt  2 , L Elopre  2 , T V Smith  1 , T Simpson  1 , R Lanzi  3 , L T Matthews  2
Affiliations

"Let's take that [stop sign] down." Provider perspectives on barriers to and opportunities for PrEP prescription to African American girls and young women in Alabama

Samantha V Hill et al. AIDS Care. 2022 Nov.

Abstract

HIV disproportionately impacts many groups, including Black adolescent girls and young women (AGYW) aged 13-24 living in the Deep South. Current prevention efforts have the potential to further exacerbate disparities within this population as HIV pre-exposure prophylaxis (PrEP) remains underutilized by Black AGYW in the South. We conducted in-depth interviews (IDIs) grounded in Andersen's Model of Healthcare Utilization exploring providers' PrEP prescribing practices to Black AGYW in Alabama. Eleven providers completed IDIs exploring providers' PrEP prescription knowledge and experiences. Cross-cutting themes included: (1) Community and provider-level stigmas (including those propagated by legislation) relating to HIV and sexuality limit sexual health discussions with Black AGYW clients; (2) Low PrEP knowledge and comfort with guidelines limits PrEP conversations and reinforces low uptake and prescriptions; (3) Healthcare systems and structural barriers impede PrEP access for youth. Multi-level (structural, community, and provider) barriers to PrEP prescription demands high activation energy for providers to prescribe PrEP. We present recommendations in training in sexual health assessment, updates to PrEP guidelines to accommodate risk assessment appropriate for AGYW, and increased implementation science focused on PrEP prescription for Black AGYW in order to reduce HIV incidence for this population.

Keywords: HIV prevention; PrEP; adolescents; heterosexual women.

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Conflict of interest statement

Disclosure Statement

In accordance with the Taylor and Francis policy and my ethical obligation as a researcher, I am reporting that Drs. Hill and Elopre are consultants to MedIQ, a company that receives some grant funding from Gilead Sciences, a company that may be affected by the research reported in the enclosed paper. We have disclosed those interests fully to Taylor and Francis, and I have in place an approved plan for managing any potential conflicts arising from that involvement. Dr. Matthews receives operational support for NCT03832530 and NCT03194308 from Gilead Pharmaceuticals.

Figures

Figure 1.
Figure 1.
This figure displays the three main constructs of Andersen’s Behavioral Model of Health Service Utilization (Bradley, et al., 2002)- environment, health behavior, and client characteristics- and how the Situated Information, Motivation, Behavioral (sIMB) model is incorporated within the health behaviour construct to guide intervention development.
Figure 2.
Figure 2.
This figure illustrates how each subtheme maps to the overall emergent themes and constructs from Andersen’s Behavioral Model of Health Care Utilization.
See this image and copyright information in PMC

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