Transcript HIV-related Stigma Attributed to PrEP Use

Patterns of Sex and PrEP in
Harlem MSM: A qualitative
study (HPTN 067)
Julie Franks1, Yael Hirsch-Moverman1,2, Avelino S. Loquere Jr1, K. Rivet Amico3, Bonnie J. Dye4,
Laura McKinstry5, Robert M. Grant6, Sharon B. Mannheimer7,1,2
1. ICAP, Columbia University Mailman School of Public Health, New York, New York, United States 2. Department of
Epidemiology, ICAP, Columbia University Mailman School of Public Health, New York, New York, United States 3.
Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, United States 4. FHI
360, Durham, North Carolina, United States 5. Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
6. Gladstone Institutes, University of California, San Francisco, California, United States 7. Department of Medicine, Harlem
Hospital Center, New York, New York, United States
Qualitative Sub-Study in Harlem
Qualitative Sample Demographic Characteristics
FG
(n=31)
IDI
(n=6)
Total
(n=37)
34
36
34
Gender identity
MSM
TGW
100%
0
83%
17%
97%
3%
Race
Black
White
Asian
Other
68%
10%
10%
13%
67%
17%
0
17%
68%
11%
8%
14%
Hispanic ethnicity
29%
17%
27%
Unemployed
65%
83%
68%
Data Collection
•
•
•
•
6 Focus Groups (FG)
6 In-depth Interviews (IDI)
2 FG and 2 IDI per arm
Semi-structured guides
explored experiences with
PrEP
– Social interactions about
PrEP
– Adherence challenges
Median age (years)
No significant demographic differences between qualitative
and other study participants (data not shown)
Data Analysis
• Verbatim transcripts coded and analyzed
using the constant comparative method
• Coded excerpts were categorized as
themes corresponding to domains of our
qualitative research questions
The Value of PrEP
Theme
Illustrative Quotes
Arm
Wonder drug
Yes, this is a wonder drug.
D
I used to call that the Superman pill.
T
Alleviation of
anxiety
I was protected. Like that was my older brother and I was getting
beat up by the bully at school.
T
Prevention
Awareness
Taking the pill continually reminded me to protect myself from HIV.
E
Combination
prevention
Everybody . . . should use both, condoms and PrEP. People who
use condoms shouldn’t be opposed to PrEP and people who use
PrEP shouldn’t be opposed to using condoms.
T
HIV-related Stigma Attributed to PrEP Use
Theme
Illustrative Quotes
Arm
HIV-related
stigma
Even if I told them it was just a study, maybe some of them
wouldn’t believe it, and put some ideas into people’s heads that I
did have HIV.
T
That stigma - AIDS. You telling them you’re taking a pill to prevent
it; they thinking you taking a pill to stop it.
E
Promiscuity-related Stigma Attributed to
PrEP Use
Theme
Illustrative Quotes
Arm
Promiscuityrelated
stigma
One of my partners was like, “Whoa. What does this mean? What
are you doing?” Indicating that taking the pill means that I’m willynilly having unprotected sex.
D
A few of them were just like – “I’d rather not have sex with you
because I don’t know if PrEP works,” or “You’re probably just like a
big whore.”
D
Countering Stigma around PrEP
Theme
Illustrative Quotes
Arm
Doctors
question
My primary care doctor was opposed to it, . . . she said, “You don’t
have HIV, why do you want this?” But I explained to her.
D
Family
questions
My aunt said, “Wait, why are you in the study? Like are you HIV
positive?” I said, “No, I’m not. I’m just joining the study because I
want it to succeed, because then people won’t get HIV.”
T
Friends
question
They thought the only reason you’re on it is because you have HIV,
and I asked, “Should I give my results to the HIV [test]?
D
Stigma and Adherence to PrEP
Theme
Illustrative Quotes
Arm
Pills and sex
don’t mix
I would think [taking pills during sex] may also spoil the mood.
And maybe make the other person, especially if they are not on
the pill, so to speak, maybe even feel a little bit awkward.
D
Partners
question
My partners would be like, “Why are you taking those pills?” [and]
sometimes it would never get to the intercourse part. It would just
stop the night. They would be mad and leave.
E
Need to be
discreet
If you got a steady partner you know when you are going to do it
or not. You can have [the pill]; ‘Hold on, let me go to the
bathroom’ - pop it. Because . . . some people are not ready to just
accept things. They live in - - in a fantasy world where you don’t
think it can happen to you
E
Summary
• Our qualitative sample of mostly Black MSM
valued PrEP as a significant improvement over
existing HIV prevention strategies
• Participants described strengthening their existing
HIV prevention strategies by incorporating PrEP
• Disclosing PREP use led to stigmatizing
attributions as either HIV-infected or as sexually
promiscuous
• Anticipated or experienced stigma created
barriers to adherence to sex-dependent doses
Limitations
• Qualitative sub-study recruited a convenience
sample; not representative of all study participants or
PrEP users
• Social desirability bias may have limited participants’
willingness to share some experiences and opinions
in setting of FG and IDI
Conclusions
• Study highlights need for community-level
education to build social support for taking PrEP
• Interventions to address HIV-related stigma in
the context of PrEP use are needed for Black
MSM in the US
“It’s just freedom. I feel like my entire life I’ve
never, ever been free and now I do feel a
certain amount of freedom.”
- Daily arm IDI, 57 years old
Poster TULBPE21 July 21st, 2015
ACKNOWLEDGEMENTS
The HIV Prevention Trials Network is sponsored by the
National Institute of Allergy and Infectious Diseases,
the National Institute of Mental Health, and the National
Institute on Drug Abuse, all components of the
U.S. National Institutes of Health.
The HPTN 067 Harlem Qualitative Sub-Study Team acknowledges:
Our participants
Study staff at Harlem Prevention Center and Bronx Prevention Center
Harlem Hospital Infectious Disease Community Advisory Board
The Harlem Community
HPTN Leadership and Operations Center
HPTN Statistical and Data Management Center