Clinic-Level Strategies for Mitigating Structural and Interpersonal HIV Pre-Exposure Prophylaxis Stigma

Area of Science:

• Public Health
• HIV Prevention
• Health Services Research

Background:

• Pre-exposure prophylaxis (PrEP) uptake and adherence in the United States remain suboptimal.
• Existing and novel PrEP delivery methods face challenges due to structural and interpersonal barriers.

Purpose of the Study:

• To explore barriers and facilitators to PrEP implementation from the perspective of US-based PrEP providers.
• To identify strategies for improving PrEP access and addressing disparities.

Main Methods:

• Qualitative study involving in-person and telephone interviews with 32 clinical and nonclinical PrEP providers.
• Providers represented diverse roles and geographic regions across the US.
• Recruitment occurred at HIV prevention conferences and networks.

Main Results:

• Providers identified insurance coverage, clinical protocols, provider bias, stigma, and healthcare mistrust as key barriers.
• Clinic-level interventions such as normalizing PrEP services, patient-centered counseling, and valuing staff/community engagement were recommended.
• Acknowledging the link between stigma and structural barriers is essential for equitable PrEP access.

Conclusions:

• Effective PrEP implementation requires addressing both interpersonal stigma and systemic structural barriers.
• Provider-recommended strategies focus on normalizing services and enhancing patient-centered care to improve access and reduce disparities.