Evidence of Potential Discriminatory HIV Pre-Exposure Prophylaxis (PrEP) Prescribing Practices for People Who Inject Drugs Among a Small Percentage of Providers in the U.S. J Prim Care Community Health 2022;13:21501319211063999
Date
01/25/2022Pubmed ID
35068243Pubmed Central ID
PMC8796077DOI
10.1177/21501319211063999Scopus ID
2-s2.0-85123489777 (requires institutional sign-in at Scopus site) 5 CitationsAbstract
INTRODUCTION: A large percentage of people who inject drugs (PWID) are living with HIV. Yet, rates of HIV pre-exposure prophylaxis (PrEP) use among PWID remain low. Stigma surrounding substance use and PWID have been identified as potential barriers to PrEP. This study examined healthcare providers' concerns regarding PWID and willingness to prescribe PrEP to PWID.
METHODS: An online, cross-sectional survey of a diverse group of healthcare providers in the 10 U.S. cities with the greatest HIV prevalence was conducted between July 2014 and May 2015. Participants responded to a patient vignette of a PWID and asked to indicate whether the patient would be a candidate for PrEP and why via free-response text. Descriptive statistics are reported using frequency measures. Bivariate analyses were conducted using chi-squared comparisons and logistical regression.
RESULTS: Survey data from 480 providers were included in analyses. Of the 480 responses, 85.5% were classified as PrEP aware, while 14.2% were PrEP unaware. Additionally, 82.6% indicated the patient would be a good candidate for PrEP, 4.4% believed the patient was not a good candidate for PrEP, and 13% were unsure. Among those who were unsure or would not prescribe PrEP (n = 84), open-ended responses indicated lack of knowledge (42.9%), concern about adherence (27.4%), concern about cost (4.8%), and bias (7.1%) as the primary reasons.
CONCLUSIONS: Although the majority of providers in this study did not demonstrate bias against PWID, our study found that limited PrEP knowledge and bias are barriers to PrEP prescription among PWID for some providers. Interventions are needed that increase PrEP awareness of CDC guidelines and reduce implicit bias among providers.
Author List
Pleuhs B, Mistler CB, Quinn KG, Dickson-Gomez J, Walsh JL, Petroll AE, John SAAuthors
Julia Dickson-Gomez PhD Professor in the Institute for Health and Equity department at Medical College of WisconsinSteven A. John PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Andrew Petroll MD Professor in the Medicine department at Medical College of Wisconsin
Katherine Quinn PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Jennifer L. Walsh PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Anti-HIV AgentsCross-Sectional Studies
Drug Users
HIV Infections
Humans
Pre-Exposure Prophylaxis
Substance Abuse, Intravenous
