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From declining PrEP to PrEP initiation as "first nature" - what changes PrEP initiation decisions among young, Black
Wenting Huang1, Annie Lockard2, Colleen F Kelley3
1Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
AIDS Care
|August 9, 2021
Summary
Many young Black men who have sex with men (YBMSM) eventually start HIV pre-exposure prophylaxis (PrEP) after initially declining it. Health providers should offer PrEP routinely over time, emphasizing benefits rather than concerns.
Area of Science:
- Public Health
- HIV Prevention
- Behavioral Science
Background:
- Young Black men who have sex with men (YBMSM) experience a high burden of HIV.
- Uptake of HIV pre-exposure prophylaxis (PrEP) remains low in this population.
- PrEP decision-making is dynamic and influenced by life context.
Purpose of the Study:
- To explore the process of PrEP decision changes in YBMSM who initially declined but later initiated PrEP.
- To understand the factors influencing shifts in PrEP decisional balance over time.
Main Methods:
- Longitudinal cohort study involving YBMSM.
- Qualitative interviews using a positive deviance framework.
- Participants reviewed past statements about declining PrEP in follow-up interviews.
Main Results:
- Approximately one-third of YBMSM who initially declined PrEP later initiated care.
- Initiation of PrEP occurred despite participants maintaining significant reservations.
- No consistent factors universally prevented or facilitated PrEP uptake.
Conclusions:
- PrEP initiation is a longitudinal process, not a one-time decision.
- Health practitioners should offer PrEP routinely and repeatedly over time.
- Emphasizing diverse PrEP benefits is more effective than addressing all concerns to facilitate uptake.
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