April 4-6, 2024 • Hyatt Regency • Lexington, KY
Innovations in Health Communication
Innovations in Health Communication
Abstract: Application of the Disclosure Decision-Making Model: How Black Women Navigate PrEP Conversations
BACKGROUND:
Black Women 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 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 Black Women’s PrEP uptake lags far behind White Women’s. PrEP related disclosure decisions are important components of interpersonal interactions in health. The Disclosure Decision-Making Model (DD-MM) asserts that people evaluate information through multiple perceived factors of the disclosure. This process is then repeated for multiple targets and when new information becomes available. With Black Women accounting for a large number of HIV diagnoses in the U.S., their access to PrEP requires them to disclose needing this medication to various parties, such as healthcare providers. Thus, through the DD-MM, this study investigates how Black Women make complex disclosure decisions to both providers and intimate partners about PrEP.
METHODS:
In collaboration with The Women’s Collective in Washington, D.C., a community-based organization focused on supporting Black Women’s HIV prevention and treatment, we recruited cisgender, Black Women (n = 30) to complete 60-minute in-depth interviews. Respondents were age 18+ and reported at least one HIV behavioral risk factor. Themes were deduced from the data.
FINDINGS:
Overall, Black Women reported minimal knowledge and awareness surrounding PrEP. After learning about PrEP during the interview, the women found that PrEP was not relevant, a component of information assessment, to their health conversations with providers because they cited that they are either not sexually active or at risk for HIV. Respondents also reported that their healthcare providers do not facilitate conversations about PrEP with them. Therefore, women may not disclose HIV risk to providers because they do not perceive PrEP as relevant to them, and providers do not initiate the discussion. Another finding is that when thinking about disclosing to their intimate partners that they might want to begin PrEP, their partners’ negative anticipated responses, a component of recipient assessment, was a factor in them being hesitant or unwilling to disclose a desire to start the medication. When respondents perceived the relational quality of their intimate relationships as positive, they were then more willing to disclose (disclosure efficacy) based on supportive anticipated responses. In addition, women who cited having positive relationships with their providers were more willing to disclose wanting to begin PrEP if the conversation ever arose in their patient-provider interactions.
CONCLUSIONS:
These results suggest that provider’s disclosure of PrEP to women who may be eligible for it is a critically important mechanism for improving equitable uptake. Women in this study met HIV risk related criteria for PrEP indications, but low risk perceptions. As a result, they are unlikely to initiate HIV prevention discussions with providers. Simultaneously, respondents reported that providers do not disclose PrEP information to them. This circular problem may be circumvented through theoretically grounded communication intervention.
Black Women 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 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 Black Women’s PrEP uptake lags far behind White Women’s. PrEP related disclosure decisions are important components of interpersonal interactions in health. The Disclosure Decision-Making Model (DD-MM) asserts that people evaluate information through multiple perceived factors of the disclosure. This process is then repeated for multiple targets and when new information becomes available. With Black Women accounting for a large number of HIV diagnoses in the U.S., their access to PrEP requires them to disclose needing this medication to various parties, such as healthcare providers. Thus, through the DD-MM, this study investigates how Black Women make complex disclosure decisions to both providers and intimate partners about PrEP.
METHODS:
In collaboration with The Women’s Collective in Washington, D.C., a community-based organization focused on supporting Black Women’s HIV prevention and treatment, we recruited cisgender, Black Women (n = 30) to complete 60-minute in-depth interviews. Respondents were age 18+ and reported at least one HIV behavioral risk factor. Themes were deduced from the data.
FINDINGS:
Overall, Black Women reported minimal knowledge and awareness surrounding PrEP. After learning about PrEP during the interview, the women found that PrEP was not relevant, a component of information assessment, to their health conversations with providers because they cited that they are either not sexually active or at risk for HIV. Respondents also reported that their healthcare providers do not facilitate conversations about PrEP with them. Therefore, women may not disclose HIV risk to providers because they do not perceive PrEP as relevant to them, and providers do not initiate the discussion. Another finding is that when thinking about disclosing to their intimate partners that they might want to begin PrEP, their partners’ negative anticipated responses, a component of recipient assessment, was a factor in them being hesitant or unwilling to disclose a desire to start the medication. When respondents perceived the relational quality of their intimate relationships as positive, they were then more willing to disclose (disclosure efficacy) based on supportive anticipated responses. In addition, women who cited having positive relationships with their providers were more willing to disclose wanting to begin PrEP if the conversation ever arose in their patient-provider interactions.
CONCLUSIONS:
These results suggest that provider’s disclosure of PrEP to women who may be eligible for it is a critically important mechanism for improving equitable uptake. Women in this study met HIV risk related criteria for PrEP indications, but low risk perceptions. As a result, they are unlikely to initiate HIV prevention discussions with providers. Simultaneously, respondents reported that providers do not disclose PrEP information to them. This circular problem may be circumvented through theoretically grounded communication intervention.