From declining PrEP to PrEP initiation as "first nature" - what changes PrEP initiation decisions among young, Black MSM

• Type of Material: Article
• Authors: Wenting Huang, Emory University; Annie Lockard, Emory University; Colleen Kelley, Emory University; David P Serota, University of Miami; Charlotte-Paige M Rolle, Orlando Immunology Center; Patrick Sullivan, Emory University; Eli Rosenberg, Emory University; Aaron Siegler, Emory University
• Language: English
• Date: 2021-08-03
• Publisher: ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Rights managed by Taylor & Francis
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1080/09540121.2021.1960946
• Title of Journal or Parent Work: AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV
• Volume: 34
• Issue: 3
• Start Page: 284
• End Page: 293
• Keywords: Social Sciences; Psychology; Health Care Sciences & Services; Biomedical Social Sciences; FACILITATORS; Public, Environmental & Occupational Health; RACIAL DISPARITIES; Health Policy & Services; RISK; Young Black men who have sex with men; INFECTION; BARRIERS; Science & Technology; pre-exposure prophylaxis; Psychology, Multidisciplinary; SEX; HIV PREEXPOSURE PROPHYLAXIS; Social Sciences, Biomedical; HEALTH-CARE; Life Sciences & Biomedicine; Respiratory System; WHITE MEN; ATLANTA

Abstract

Young Black men who have sex with men (YBMSM) bear a disproportionate burden of HIV, and HIV pre-exposure prophylaxis (PrEP) uptake has been slow. Decisions regarding PrEP initiation change in different life contexts over time. Our YBMSM cohort study found about 1/3 of those who initially declined PrEP subsequently changed and initiated PrEP care. This study explores the process of their PrEP decision changes. The study interviewed participants who initially voiced strong and clear reservations about PrEP, but subsequently started PrEP 1–14 months later. In “review/renew” follow-up interviews, participants reviewed their past statements from a time they declined PrEP, and renew their understanding regarding perspective and behavioral change. Analyzing the data with a positive deviance framework, we found that shifting the decisional balance in favor of PrEP initiation only required change in some areas. There were not consistent factors that prevented or facilitated PrEP uptake. Instead, YBMSM initiated PrEP while maintaining an array of substantial reservations. PrEP initiation discussions should be viewed by health practitioners as a longitudinal process, and routine PrEP offers should be made over time. To optimally facilitate PrEP use among YBMSM, the diverse benefits of PrEP should be emphasized rather than focusing on allaying all concerns.