Black women in the United States remain at a higher risk of HIV infection compared to white or Latinx women. Despite this, pre-exposure prophylaxis (PrEP), an effective therapy for decreasing HIV transmission, is underutilized in black women, according to a recent study.

The study, released in the AIDS and Behavior Journal, sought to determine the role of HIV related medical mistrust, and willingness to use PrEP among black women in the United States.

In the study, multiple factors were cited as cause for black women to take PrEP less often than other ethnic groups.

The most common reason was that the participants did not think they were at risk of HIV infection. Discordance between self-perceived risk and actual risk lowered PrEP intake. Indeed, clinicians often overlooked black women’s elevated risk of HIV infection.

The second most common reason for not taking PrEP was the belief that it would not work to prevent HIV transmission. Fear of adverse effects was another large factor.

Many women also were unaware of the existence of PrEP, showing that there is a lack of counseling and education on PrEP. Concerns about the cost of PrEP were also present, despite programs designed to reduce PrEP’s cost.

Pharmacists can play a large role in educating patients on these programs.

Additionally, this study identified certain beliefs or medical mistrust that prevent PrEP use in black women. About half of the women surveyed thought “there is a cure for HIV but the government is withholding it from the poor” or that “HIV was a man-made virus.” Some thought that the medicine prescribed to treat HIV was actually poison and that governments do not usually tell the truth about major health issues like HIV/AIDS.

These beliefs can damage provider-patient relationships, but this study found that participants who endorsed these beliefs were more willing to use PrEP. This could be because the use of PrEP is seen as a form of empowerment in these patients, a way to take back control from perceived mistreatment, according to the authors.

Culturally competent providers should be able to discuss these beliefs with patients with the aim not to dispel them but to shift their perception on PrEP use. 
 
Ivan Navarro, 2020 PharmD Candidate at the University of Connecticut in Storrs.


REFERENCE

Ojikutu, B.O., Amutah-Onukagha, N., Mahoney, T.F. et al. HIV-Related Mistrust (or HIV Conspiracy Theories) and Willingness to Use PrEP Among Black Women in the United States. AIDS Behav (2020). https://doi.org/10.1007/s10461-020-02843-z