Online Program

Race and the public health impact potential of PrEP in the United States

Wednesday, November 4, 2015 : 8:45 a.m. - 9:00 a.m.

John Schneider, MD, MPH, Department of Medicine and Public Health Sciences, University of Chicago, Chicago, IL
Issues:  Early evidence is emerging around racial disparities in PrEP-knowledge, -healthcare seeking behavior, and -uptake. Few Black men who have sex with men (MSM) are engaged in PrEP implementation projects, which is striking, given that there is high and increasing HIV incidence among younger Black MSM in major urban areas across the U.S. These worrisome trends are emerging at a time when many Black communities are expected to have increased health care access as the Affordable Care Act is fully implemented.

Description: PrEP Chicago is an intervention that couples network level diffusion of innovation with linkage to PrEP care in community areas at high risk for ongoing HIV transmission. Early diffusion including knowledge, preparation and adoption are a major focus. Purposeful selection and training of peer change agents to drive diffusion through person to person communication and motivation leads to PrEP engagement and linkage to care. 

Lessons Learned: Diffusion of innovation in community areas such as the South Side is largely word of mouth and most effective from a grassroots or bottom-up approach.  While Medicaid expansion makes PrEP care more accessible, navigation of different medical homes, insurance providers and referral restrictions adds additional complications to PrEP care engagement. In contexts without Medicaid expansion, additional barriers likely exist.

Recommendations: Real-world PrEP access and utilization by those with highest HIV incidence, such as younger Black MSM, faces major implementation challenges that require purposeful and sustained engagement with racial/ethnic minority communities and navigation of a complicated health care environment.

Learning Areas:

Provision of health care to the public
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Describe facilitators and barriers to PrEP engagement in urban settings Analyze emerging racial disparities in PrEP engagement

Keyword(s): HIV/AIDS, African American

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a MD and MPH, have been the principal or co-principal of multiple federally funded grants focusing on the epidemiology of HIV prevention, younger Black MSM HIV prevention and network analysis. Among my scientific interests has been the development of strategies for HIV prevention engagement.
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.