The Role of Social Biases, Race, and Condom Use in Willingness to Prescribe HIV Pre-exposure Prophylaxis to MSM: An Experimental, Vignette-Based Study.

Autor:	Bunting SR; Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine, Chicago, IL., Feinstein BA; Department of Psychology, College of Health Professions, Rosalind Franklin University, North Chicago, IL., Calabrese SK; Department of Psychological and Brain Sciences, George Washington University, Washington, DC., Hazra A; Section of Infectious Diseases and Global Health, Department of Medicine, the University of Chicago Medicine, Chicago, IL., Sheth NK; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL., Wang G; Pritzker School of Medicine, The University of Chicago, Chicago, IL; and., Garber SS; Department of Pharmaceutical Sciences, College of Pharmacy, Rosalind Franklin University, North Chicago, IL.
Jazyk:	angličtina
Zdroj:	Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2022 Dec 01; Vol. 91 (4), pp. 353-363. Date of Electronic Publication: 2022 Aug 19.
DOI:	10.1097/QAI.0000000000003072
Abstrakt:	Introduction: Daily antiretroviral pre-exposure prophylaxis (PrEP) is a safe and effective method of preventing HIV. Clinicians' assumptions, biases, and judgments may impede access to PrEP. Specifically, concern that patients will engage in more condomless sex ("risk compensation") has been cited by clinicians as a reason for not prescribing PrEP. Methods: In this experimental study among medical students, we systematically varied race (White or Black) and condom-use behaviors (continued-use, planned-discontinuation, or continued-nonuse) of a fictional patient (all men with multiple male sex partners). Participants indicated the patients' assumed adherence to PrEP, patients' overall HIV risk, and willingness to prescribe PrEP. Participants completed an implicit association test to detect implicit racism and measures of heterosexism and attitudes toward nonmonogamy, which were examined as moderators of patient race and condom-use effects on participants' assumptions and ultimate willingness to prescribe PrEP. Results: Participants ( N = 600) were most willing to prescribe PrEP to the continued-nonuse patient and least willing to prescribe to the planned-discontinuation patient. No differences were identified based on patient race. The continued-nonuse (vs. continued-use) patient was perceived as less likely to adhere to PrEP, which was associated with lower willingness to prescribe. Negative attitudes toward nonmonogamy exacerbated this effect. No effects of implicit racism or explicit heterosexism were identified. Conclusions: Participants were least willing to prescribe PrEP to patients who planned to discontinue condom use. Patients seeking PrEP are exhibiting agency over their sexual health, and clinicians should fulfill their role in ensuring access to this primary preventative therapy. Training and curricular reform regarding PrEP are needed. Competing Interests: The authors have no conflicts of interest to disclose. (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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