April 4-6, 2024 • Hyatt Regency • Lexington, KY
Innovations in Health Communication
Innovations in Health Communication
Abstract: Cisgender Black Women’s Perceptions and Interactions with Pre-Exposure Prophylaxis: A Preliminary Thematic Analysis
Black Women (BW) account for 53% of HIV diagnoses among Women in the United States (U.S.). Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention medication that reduces the chances of HIV infection by up to 92%. PrEP may be especially useful for Women, as it can circumvent gendered barriers to condom use. However, only 10.4% of Women eligible for PrEP have accessed a prescription, and BW’s PrEP uptake lags far behind White Women’s.
Intersectionality framework underscores how factors shaping PrEP inequities are rooted in gendered, racialized power differentials. BW cite health care providers and partners as important normative referents in the decision to utilize PrEP. However, providers demonstrate less willingness to discuss or prescribe PrEP to BW, relative to White Women, due to assumptions that BW will be non-adherent. When BW do receive prescriptions, low quality interactions with providers can undermine adherence. BW also voiced obligations to disclose PrEP use to partners, which undermines PrEP’s power to be discrete and autonomously controlled. These barriers may be navigated through communication skills training, including self-advocacy and sexual negotiation.
Method. We adapted Sisters Informing Sisters about Topics on AIDS (SISTA), an outdated, condom-focused, gender- and culture-specific evidence-based intervention for BW, to include biomedical prevention tools. In collaboration with The Women’s Collective in Washington, D.C., a community-based organization focused on supporting BW’s HIV prevention and treatment, we recruited BW (n = 30) to complete 60-minute in-depth interviews to develop SISTA-P. Two coders reached acceptable inter-coder reliability. SISTA-P is a 6-session, group-based intervention that applies an empowerment approach to address BW’s needs.
Results. Respondents reported perceptions of relatively low risk of HIV infection, despite their eligibility for study inclusion, which required the presence of at least one HIV risk factor. Supporting previous studies, BW had low awareness of PrEP, and those who are aware often understand PrEP as only for Men who have Sex with Men (MSM). After learning more about PrEP, BW thought PrEP was helpful, but not for them personally. While PrEP awareness was low, BW acknowledged its potential utility and had a strong desire to cultivate and maintain physical and emotional wellness. Respondents then remarked that PrEP can play an important role in their prioritization and enactment of self-care. Simultaneously, BW described low levels of social support in their self-care, and deeply felt gender-based familial obligations, which complicated BW’s capacity to prioritize self-care. Partner resistance to using PrEP was anticipated, possibly creating or magnifying conflict. Still, BW were willing to negotiate safer sex with their partners. They also reported receiving poor quality of care from providers concerning HIV prevention, with providers rarely discussing sexual health. Further, BW shared they were disrespected and/or disregarded in communicative interactions with providers.
SISTA-P assists BW in overcoming individual, partner, health care provider and substance use-related barriers to PrEP uptake by cultivating HIV prevention and PrEP knowledge, fostering social and emotional support to practice HIV prevention as self-care, and bolstering skills to self-advocate and negotiate biomedical prevention with providers and partners.
Intersectionality framework underscores how factors shaping PrEP inequities are rooted in gendered, racialized power differentials. BW cite health care providers and partners as important normative referents in the decision to utilize PrEP. However, providers demonstrate less willingness to discuss or prescribe PrEP to BW, relative to White Women, due to assumptions that BW will be non-adherent. When BW do receive prescriptions, low quality interactions with providers can undermine adherence. BW also voiced obligations to disclose PrEP use to partners, which undermines PrEP’s power to be discrete and autonomously controlled. These barriers may be navigated through communication skills training, including self-advocacy and sexual negotiation.
Method. We adapted Sisters Informing Sisters about Topics on AIDS (SISTA), an outdated, condom-focused, gender- and culture-specific evidence-based intervention for BW, to include biomedical prevention tools. In collaboration with The Women’s Collective in Washington, D.C., a community-based organization focused on supporting BW’s HIV prevention and treatment, we recruited BW (n = 30) to complete 60-minute in-depth interviews to develop SISTA-P. Two coders reached acceptable inter-coder reliability. SISTA-P is a 6-session, group-based intervention that applies an empowerment approach to address BW’s needs.
Results. Respondents reported perceptions of relatively low risk of HIV infection, despite their eligibility for study inclusion, which required the presence of at least one HIV risk factor. Supporting previous studies, BW had low awareness of PrEP, and those who are aware often understand PrEP as only for Men who have Sex with Men (MSM). After learning more about PrEP, BW thought PrEP was helpful, but not for them personally. While PrEP awareness was low, BW acknowledged its potential utility and had a strong desire to cultivate and maintain physical and emotional wellness. Respondents then remarked that PrEP can play an important role in their prioritization and enactment of self-care. Simultaneously, BW described low levels of social support in their self-care, and deeply felt gender-based familial obligations, which complicated BW’s capacity to prioritize self-care. Partner resistance to using PrEP was anticipated, possibly creating or magnifying conflict. Still, BW were willing to negotiate safer sex with their partners. They also reported receiving poor quality of care from providers concerning HIV prevention, with providers rarely discussing sexual health. Further, BW shared they were disrespected and/or disregarded in communicative interactions with providers.
SISTA-P assists BW in overcoming individual, partner, health care provider and substance use-related barriers to PrEP uptake by cultivating HIV prevention and PrEP knowledge, fostering social and emotional support to practice HIV prevention as self-care, and bolstering skills to self-advocate and negotiate biomedical prevention with providers and partners.