Online Program

Racial bias in provider decision-making surrounding HIV pre-exposure prophylaxis (PrEP): Assumptions of greater sexual risk compensation among black versus white men who have sex with men and implications for access

Wednesday, November 6, 2013 : 12:30 p.m. - 12:45 p.m.

Sarah K. Calabrese, Ph.D., Yale School of Public Health/ Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT
Valerie A. Earnshaw, Ph.D., Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT
Nathan B. Hansen, Ph.D., Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT
John F. Dovidio, Ph.D., Department of Psychology, Yale University, New Haven, CT
Kristen Underhill, D.Phil., J.D., Yale Law School/ Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT
Background: Pre-exposure prophylaxis (PrEP) has gained momentum as a promising new prevention strategy for people at high risk for HIV acquisition. However, little is known about personal biases and clinical considerations affecting health care providers' willingness to prescribe PrEP to patients of diverse backgrounds. The purpose of the current investigation was to explore providers' predictions about sexual risk compensation among Black versus White MSM seeking PrEP and the impact of such judgments on willingness to prescribe. Methods: An online survey presented medical students with a clinical vignette of a PrEP-seeking, HIV-negative man with an HIV-positive male partner. Patient race (Black or White) was systematically manipulated. Participants (n=102) reported judgments of perceived likelihood of patient risk compensation, willingness to prescribe PrEP, and other clinical considerations (e.g., perceived benefit of PrEP, likelihood of HIV acquisition without PrEP, likelihood of PrEP adherence). Results: Bootstrapping analyses revealed a significant indirect effect of patient race on participant willingness to prescribe PrEP via predicted patient sexual risk compensation controlling for participant sociodemographic characteristics and other clinical considerations [95% CIs (-0.29, -0.02)]. Thus, the Black patient was judged as more likely than the White patient to increase unprotected sex if prescribed PrEP, which was associated with reduced participant willingness to prescribe PrEP to the patient. Conclusions: Given the potential utility of PrEP for people at risk for HIV acquisition, identifying and addressing potential barriers to access is important. Interventions to combat the influence of race-based stereotypes on clinical decision-making and prescription practices surrounding PrEP should be implemented.

Learning Areas:

Chronic disease management and prevention
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
Describe the impact of patient race on providers’ judgment of patient sexual risk compensation if prescribed PrEP and implications for willingness to prescribe

Keyword(s): HIV Interventions, Minority Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have earned a Ph.D. in clinical psychology and been awarded a National Research Service Award from the National Institute of Mental Health (NIMH) for my research on HIV prevention and sexual stereotypes in the Black community. As an NIMH-funded postdoctoral fellow at Yale University's Center for Interdisciplinary Research on AIDS, I continue to conduct research that focuses on understanding and addressing racial disparities in HIV prevalence and care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5173.0: PrEP and HIV prevention