The Association Between Medical Distrust and the Intention to Initiate Preexposure Prophylaxis (PrEP) in HIV-Seronegative Cisgender Women of Color Within the DC Area [ID: 1377701]

Abstract

INTRODUCTION: Black cisgender women bear a disproportionate burden of the U.S. human immunodeficiency virus (HIV) epidemic, compared to women of other racial groups. Preexposure prophylaxis (PrEP) is a highly effective prevention tool. Evidence indicates that Black women are interested in initiating PrEP, but low utilization persists in this population. Historical mistreatment of women of color and the resulting distrust erect barriers to open communication and shared decision-making with health care providers. METHODS: Using an IRB-approved questionnaire, we surveyed 186 consenting adults (83% Black, 9% White, 3% American Indian/Alaskan Native, 4% Other), who were PrEP eligible, HIV seronegative, cisgender women, recruited from family planning and obstetrics and gynecology specialty clinics in Washington, DC. We tested the interaction of patient racial identification and group-based medical mistrust on intentions to use PrEP, as mediated by intentions to discuss PrEP with a health care provider during the imminent clinical interaction. RESULTS: Results indicate significant moderated mediation of the interaction between race and distrust on intention to initiate PrEP at 3 months (index −0.3093, SE 0.1886, 95% CI [–0.7455,–0.0122]) and 12 months (index −0.3248, SE 0.1987, 95% CI [–0.7827,–0.0040]) through anticipated discussion with a provider. CONCLUSION: When distrust is low, Black women had stronger intentions to utilize PrEP (relative to women of other racial groups). This was explained by stronger intentions to discuss PrEP with the provider during the clinical visit. This relationship was nonsignificant at moderate and high levels of distrust. These results underscore the critical importance of provider-initiated discussion of PrEP with women to improve health equity.