Systemic Bias May Prevent Individuals Who Inject Drugs From Receiving PrEP


Systematic biases about individuals who inject drugs—which may impact access to pre-exposure prophylaxis (PrEP)—exist among primary and HIV care providers, according to a study published in AIDS and Behavior. Receipt of PrEP education or prescription relies heavily on a provider’s discretion, which can be subject to social biases, according to the study.

The investigators surveyed 370 primary and HIV care providers to ascertain whether a patient’s race, sexual orientation, or injection drug use affected clinical judgment. According to the survey results, clinicians considered those who inject drugs to be less responsible, less safety-conscious, and less likely to be adherent to PrEP. Biases relating to sexual orientation were limited and there was no evidence of bias based on race.

“At a time when injection drug use is a pervasive driver of preventable illness and death in the United States, harm reduction is essential,” said Sarah Calabrese, PhD, an assistant professor of clinical psychology at George Washington University, in a press release. “Health care providers can play a pivotal role in raising awareness about PrEP and enabling access to this important preventive resource, but they are not routinely offering it to patients, particularly patients who inject drugs. We wanted to find out whether there were systematic biases against people who inject drugs in providers’ clinical judgments related to PrEP.”

The surveys were conducted by presenting participants with a fictitious medical record, which varied by race, sexual orientation, and whether the patient injected drugs, and asked these providers to review the record and make a series of clinical judgments. The investigators found that providers had less favorable judgements about patients who injected drugs, despite their recognition that these patients were at higher risk of contracting HIV than the patients with sexual risks.

The providers tended to believe that individuals who inject drugs are less likely to adhere to PrEP and less responsible than those at sexual risk, which could lead to a lower chance of the provider offering it, according to the investigators.

“Upon learning of it, many people who inject drugs have expressed positive attitudes toward PrEP,” Calabrese said in the release. “However, only about 25% of people who inject drugs in the US are aware of PrEP, and less than 1% have recently used PrEP. Our study shows the importance of raising awareness about PrEP as a preventive resource for both sexual and injection-related risks, and standardizing access to it for all people through policies and guidelines.”


New study suggests healthcare provider biases can impact a patient’s access to preventative HIV drug [news release]. EurekAlert; November 8, 2021. Accessed November 11, 2021.

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