Where's the "Everyday Black Woman"? An intersectional qualitative analysis of Black Women's decision-making regarding HIV pre-exposure prophylaxis (PrEP) in Mississippi.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Anti-HIV Agents*/therapeutic use ; HIV Infections*/drug therapy ; HIV Infections*/prevention & control ; Pre-Exposure Prophylaxis* ; Racism*; Black People ; Female ; Humans ; Mississippi ; Black or African American

Background: Black cisgender women in the U.S. South bear a disproportionate burden of HIV compared to cisgender women in other racial and ethnic groups and in any other part of the US. Critical to decreasing new HIV infections is the improved delivery of pre-exposure prophylaxis (PrEP) for Black cisgender women as it remains underutilized in 2021. Informed by intersectionality, the study sought to characterize the sociostructural influences on Black cisgender women's deliberations about PrEP within the context of interlocking systems of oppression including racism, sexism, and classism.
Methods: Six focus groups were conducted with 37 Black women residing in Jackson, Mississippi. This sample was purposively recruited to include Black cisgender women who were eligible for PrEP but had never received a PrEP prescription.
Results: Six themes were identified as concerns during PrEP deliberation among Black women: 1) limited PrEP awareness, 2) low perceived HIV risk, 3) concerns about side effects, 4) concerns about costs, 5) limited marketing, and 6) distrust in the healthcare system. Three themes were identified as facilitators during PrEP deliberations: 1) women's empowerment and advocacy, 2) need for increased PrEP-specific education, and 3) the positive influence of PrEP-engaged women's testimonials. Black women shared a limited awareness of PrEP exacerbated by the lack of Black women-specific marketing. Opportunities to support Black women-specific social marketing could increase awareness and knowledge regarding PrEP's benefits and costs. Black women also shared their concerns about discrimination in healthcare and distrust, but they felt that these barriers may be addressed by patient testimonials from PrEP-engaged Black women, empowerment strategies, and directly addressing provider biases.
Conclusions: An effective response to PrEP implementation among Black women in the South requires developing programs to center the needs of Black women and carry out active strategies that prioritize peer advocacy while reinforcing positive and mitigating negative influences from broader social and historical contexts.
(© 2022. The Author(s).)

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T32 HD064428 United States HD NICHD NIH HHS; UL1 TR001863 United States TR NCATS NIH HHS; K01 MD015005 United States MD NIMHD NIH HHS; R25 DA035692 United States DA NIDA NIH HHS; R61 HD104570 United States HD NICHD NIH HHS; L32 MD016555 United States MD NIMHD NIH HHS; P30 AI094189 United States AI NIAID NIH HHS; R25 MH083620 United States MH NIMH NIH HHS; P30 AI036214 United States AI NIAID NIH HHS; T32 HD094687 United States HD NICHD NIH HHS

Keywords: Black women; HIV; Pre-exposure prophylaxis; Racism; Sexism

0 (Anti-HIV Agents)

Date Created: 20220823 Date Completed: 20220825 Latest Revision: 20240827

20240827

PMC9396836

10.1186/s12889-022-13999-9

35999528