Assumptions about patients seeking PrEP: Exploring the effects of patient and sexual partner race and gender identity and the moderating role of implicit racism.

Autor: Bunting SR; Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, Illinois, United States of America., Feinstein BA; Department of Psychology, College of Health Professions, Rosalind Franklin University, North Chicago, Illinois, United States of America., Calabrese SK; Department of Psychological and Brain Sciences, The George Washington University, Washington, District of Columbia, United States of America., Hazra A; Section of Infectious Diseases and Global Health, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois, United States of America., Sheth NK; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, United States of America., Chen AF; Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois, United States of America., Garber SS; Department of Pharmaceutical Sciences, College of Pharmacy, Rosalind Franklin University, North Chicago, Illinois, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 Jul 01; Vol. 17 (7), pp. e0270861. Date of Electronic Publication: 2022 Jul 01 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0270861
Abstrakt: Introduction: Daily pre-exposure prophylaxis (PrEP) for HIV-prevention is an essential component of national plans to end the HIV epidemic. Despite its well-documented safety and effectiveness, PrEP prescription has not met the public health need. Significant disparities between White and Black people exist with respect to PrEP prescription, as do disparities between men and women. One factor contributing to these disparities is clinicians' assumptions about patients seeking PrEP.
Methods: The present study sought to investigate medical students' assumptions about patients seeking PrEP (anticipated increased condomless sex, extra-relational sex, and adherence to PrEP), and assumed HIV risk when presenting with their sexual partner. We systematically varied the race (Black or White) and gender (man or woman) of a fictional patient and their sexual partner. All were in serodifferent relationships including men who have sex with men (MSM), women (MSW), and women who have sex with men (WSM). Participants also completed an implicit association test measuring implicit racism against Black people. We evaluated the moderation effects of patient and partner race on assumptions as well as the moderated moderation effects of implicit racism.
Results: A total of 1,472 students participated. For MSM patients, having a Black partner was associated with higher assumed patient non-adherence to PrEP compared to a White partner, however a White partner was associated with higher assumed HIV risk. For MSW patients, a White male patient was viewed as being more likely to engage in more extra-relational sex compared to a Black male patient. For WSM patients, White women were assumed to be more likely to have condomless and extra-relational sex, be nonadherent to PrEP, and were at higher HIV risk. Overall, implicit racism was not related to negative assumptions about Black patients as compared to White patients based on patient/partner race.
Discussion: Medical education about PrEP for HIV prevention must ensure future health professionals understand the full range of patients who are at risk for HIV, as well as how implicit racial biases may affect assumptions about patients in serodifferent couples seeking PrEP for HIV prevention. As gatekeepers for PrEP prescription, clinicians' assumptions about patients seeking PrEP represent a barrier to access. Consistent with prior research, we identified minimal effects of race and implicit racism in an experimental setting.
Competing Interests: SKC reports partial support from Gilead Sciences to attend a conference in July 2019. This work was supported with unrestricted research funding through an investigator sponsored research award from Gilead Sciences. This does not alter our adherence to PLoS ONE policies on sharing data and materials. The authors declare that they have no other, relevant conflicts of interest to disclose.
Databáze: MEDLINE
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