Yale University

Pre-exposure prophylaxis, medical mistrust, stigma, and medication beliefs among a diverse sample of young adult men

Principle Investigator(s):

Funder: National Institute of Mental Health
Project period: 05/31/2018 - 05/30/2019
Grant Type: Pilot Project

Abstract Text:

The proposed mixed methods investigation aims to advance our knowledge about the beliefs and experiences of young men who have sex with men (MSM) related to pre-exposure prophylaxis (PrEP) and HIV. The study will take place within the context of an NIH-funded project, Syndemic Production Among Emergent Adult Men, through New York University’s Center for Health, Identity, Behavior, and Prevention Studies, commonly known as CHIBPS (PI: Dr. Perry Halkitis and Co-I Dr. Farzana Kapadia). This study will broadly examine pre-exposure prophylaxis (PrEP) and HIV in the context of medical and health-related mistrust. Of particular interest is illuminating young MSM’s beliefs, concerns and perceptions about PrEP, including medication beliefs and stigma beliefs.
Although PrEP is an extremely effective method of preventing HIV among MSM, uptake has been lagging, particularly among those populations that are considered most at risk for HIV. The extant literature exploring the underlying contributors to this slow uptake has identified several factors, including cost, health insurance and access to healthcare, as well as stigma. Most of this research has focused on structural factors, in addition to knowledge and awareness. However, there is less known about MSM’s beliefs, concerns and perceptions regarding PrEP and PrEP use. As PrEP is recommended for all individuals who engage in risk behaviors, such as condomless anal sex, it is important to understand how young MSM think about, perceive, and engage in decision-making about PrEP. Specifically, it is critical to address these beliefs, perceptions and experiences in order to maximize the impacts of PrEP. Underexplored areas in the literature include the potential roles of medical mistrust, medication beliefs and stigma in shaping how this population makes decisions about PrEP use. Health-related mistrust may include HIV-related “conspiracy beliefs”, such as the belief that the government created HIV to target minority communities, as well as mistrust of providers and/or the healthcare system. Related, beliefs about medication, both PrEPspecific and generally, should be examined, as previous research on antiretroviral-related beliefs has proven beneficial in understanding ART uptake and adherence challenges. Finally, PrEPrelated stigma must be explored beyond the associations with sexual promiscuity. By examining the relationships among PrEP uptake, medication beliefs, stigma and medical mistrust, the proposed study seeks to contribute to the scientific literature and inform intervention development in the area of increasing uptake and adherence of PrEP among this population.