Persistent stigmatizing and negative perceptions of pre-exposure prophylaxis (PrEP) users: implications for PrEP adoption among Latino men who have sex with men

ABSTRACT The Centers for Disease Control and Prevention (CDC) estimates the lifetime HIV risk is one in four for Latino men who have sex with men (MSM). Pre-Exposure Prophylaxis (PrEP) is an efficacious biomedical prevention strategy to help prevent the acquisition of HIV. At present, there has been limited uptake of PrEP by Latino MSM. Unfortunately, the negative perceptions and social stigma surrounding PrEP and those who use it may deter uptake of this novel prevention strategy, particularly among high-risk Latino MSM. In this qualitative study, we explore the experiences of using PrEP among Latino MSM. Participants were recruited using gay-oriented social and sexual networking apps to complete an interviewer-administered, semi-structured qualitative interview. Thematic analysis was used to identify emerging themes relating to perceptions of PrEP users and PrEP as an HIV prevention strategy. Major themes included: feelings of protection and sexual freedom; negative and stigmatizing labels associated with PrEP use; assumptions about sexual behaviors and perceptions of sexual risk taking and irresponsibility; and attitudes related to PrEP use in relationships. A striking but not prevalent theme was the perception reported by participants that monolingual Spanish-speaking Latino MSM are skeptical about the effectiveness of PrEP. These findings suggest that efforts are needed to address the stigmatizing and negative perceptions of PrEP that persist in the gay community that may deter adoption among Latino MSM.

[1]  M. Chiasson,et al.  ‘WTF is PrEP?’: attitudes towards pre-exposure prophylaxis among men who have sex with men and transgender women in New York City , 2018, Culture, health & sexuality.

[2]  R. Gandhi.  Preexposure Prophylaxis for the Prevention of HIV , 2018 .

[3]  K. Fujimoto,et al.  Use of Pre-exposure Prophylaxis (PrEP) in Young Men Who Have Sex with Men is Associated with Race, Sexual Risk Behavior and Peer Network Size , 2017, AIDS and Behavior.

[4]  Aerielle M. Allen,et al.  Stigma and Conspiracy Beliefs Related to Pre-exposure Prophylaxis (PrEP) and Interest in Using PrEP Among Black and White Men and Transgender Women Who Have Sex with Men , 2017, AIDS and Behavior.

[5]  J. Stekler,et al.  The Impact of HIV Pre-exposure Prophylaxis (PrEP) Use on the Sexual Health of Men Who Have Sex with Men: A Qualitative Study in Seattle, WA , 2017 .

[6]  S. Beougher,et al.  Brief Report: PrEP Uptake, Adherence, and Discontinuation Among California YMSM Using Geosocial Networking Applications , 2017, Journal of acquired immune deficiency syndromes.

[7]  J. Parsons,et al.  Exploring Patterns of Awareness and Use of HIV Pre-Exposure Prophylaxis Among Young Men Who Have Sex with Men , 2017, AIDS and Behavior.

[8]  T. Finlayson,et al.  Willingness to Take, Use of, and Indications for Pre-exposure Prophylaxis Among Men Who Have Sex With Men-20 US Cities, 2014. , 2016, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  P. Sullivan,et al.  HIV-negative male couples’ attitudes about pre-exposure prophylaxis (PrEP) and using PrEP with a sexual agreement , 2016, AIDS care.

[10]  K. Gamarel,et al.  Demographic Differences in PrEP-Related Stereotypes: Implications for Implementation , 2017, AIDS and Behavior.

[11]  Kimberly A. Koester,et al.  Sexual Behavior, Risk Compensation, and HIV Prevention Strategies Among Participants in the San Francisco PrEP Demonstration Project: A Qualitative Analysis of Counseling Notes , 2016, AIDS and Behavior.

[12]  Gaurav Dave,et al.  Experiences of Latinos with limited English proficiency with patient registration systems and their interactions with clinic front office staff: an exploratory study to inform community-based translational research in North Carolina , 2015, BMC Health Services Research.

[13]  R. Wolitski,et al.  Vital Signs: Estimated Percentages and Numbers of Adults with Indications for Preexposure Prophylaxis to Prevent HIV Acquisition--United States, 2015. , 2015, Journal of the Mississippi State Medical Association.

[14]  R. Wolitski,et al.  Vital Signs: Estimated Percentages and Numbers of Adults with Indications for Preexposure Prophylaxis to Prevent HIV Acquisition--United States, 2015. , 2015, MMWR. Morbidity and mortality weekly report.

[15]  Abigail A. Sewell.  Disaggregating ethnoracial disparities in physician trust. , 2015, Social science research.

[16]  Oona MR Campbell,et al.  A mediation approach to understanding socio-economic inequalities in maternal health-seeking behaviours in Egypt , 2015, BMC Health Services Research.

[17]  John A. Guidry,et al.  Knowledge and Attitudes About Preexposure Prophylaxis (PrEP) Among Sexually Active Men Who Have Sex with Men and Who Participate in New York City Gay Pride Events , 2014 .

[18]  S. Buchbinder,et al.  Early Experiences Implementing Pre-exposure Prophylaxis (PrEP) for HIV Prevention in San Francisco , 2014, PLoS medicine.

[19]  K. Page,et al.  Qualitative Assessment of HIV Prevention Challenges and Opportunities Among Latino Immigrant Men in a New Receiving City , 2015, Journal of Immigrant and Minority Health.

[20]  M. Mimiaga,et al.  Sexual Partnerships and Considerations for HIV Antiretroviral Pre-Exposure Prophylaxis Utilization Among High-Risk Substance Using Men Who Have Sex with Men , 2013, Archives of Sexual Behavior.

[21]  C. Hendrix,et al.  Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial , 2013, The Lancet.

[22]  John T Brooks,et al.  Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. , 2012, The New England journal of medicine.

[23]  James D. Campbell,et al.  Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. , 2012, The New England journal of medicine.

[24]  Sung-Jae Lee,et al.  Sexual risk behaviors and acceptability of HIV pre-exposure prophylaxis among HIV-negative gay and bisexual men in serodiscordant relationships: a mixed methods study. , 2012, AIDS patient care and STDs.

[25]  I. Wilson,et al.  Evaluation of the Single-Item Self-Rating Adherence Scale for Use in Routine Clinical Care of People Living with HIV , 2012, AIDS and Behavior.

[26]  K. Mayer,et al.  Predictors of HIV Transmission Risk Behavior and Seroconversion Among Latino Men Who have Sex with Men in Project EXPLORE , 2012, AIDS and Behavior.

[27]  S. Maisto,et al.  The Role of Alcohol and Substance Use in Risky Sexual Behavior Among Older Men Who Have Sex With Men: A Review and Critique of the Current Literature , 2012, AIDS and Behavior.

[28]  Sung-Jae Lee,et al.  Motivators, concerns, and barriers to adoption of preexposure prophylaxis for HIV prevention among gay and bisexual men in HIV-serodiscordant male relationships , 2011, AIDS care.

[29]  David V Glidden,et al.  Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. , 2010, The New England journal of medicine.

[30]  L. Metsch,et al.  Crystal Methamphetamine Use and Sexual Risk Behaviors among HIV-Positive and HIV-Negative Men Who Have Sex with Men in South Florida , 2010, Journal of Urban Health.

[31]  L. Torian,et al.  Perceptions of Lifetime Risk and Actual Risk for Acquiring HIV Among Young Men Who Have Sex with Men , 2007, AIDS and Behavior.

[32]  K. Hergenrather,et al.  A community-based rapid assessment of HIV behavioural risk disparities within a large sample of gay men in southeastern USA: A comparison of African American, Latino and white men , 2006, AIDS care.

[33]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[34]  E. Vittinghoff,et al.  Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of San Francisco men who have sex with men , 2005, Journal of Urban Health.