"PrEP's just to secure you like insurance": a qualitative study on HIV pre-exposure prophylaxis (PrEP) adherence and retention among black cisgender women in Mississippi.
Tiara C Willie, Mauda Monger, Amy Nunn, Trace Kershaw, Jamila K Stockman, Kenneth H Mayer, Philip A Chan, Adaora A Adimora, Leandro A Mena, Deja Knight, Karlye A Philllips, Stefan D Baral
Author Information
Tiara C Willie: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. twillie2@jhu.edu. ORCID
Mauda Monger: MLM Center for Health Education and Equity Consulting Services, Jackson, MS, USA.
Amy Nunn: Department of Psychiatry, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Trace Kershaw: Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, USA.
Jamila K Stockman: Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
Kenneth H Mayer: Harvard Medical School and Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
Philip A Chan: Department of Psychiatry, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Adaora A Adimora: Department of Medicine, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
Leandro A Mena: Department of Medicine, University of Mississippi Medical Center, Jackson, USA.
Deja Knight: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Karlye A Philllips: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Stefan D Baral: Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
BACKGROUND: Pre-exposure prophylaxis (PrEP) has the potential to reduce transmission of HIV among Black cisgender women in the Southern United States (U.S.); however, national data suggests that PrEP initiation is lowest in the South and among Black women compared to other U.S. regions and white women. This study applied intersectionality and PrEP multilevel resilience frameworks to assess how socio-structural and clinical contexts shaped PrEP persistence among Black cisgender women in Mississippi. METHODS: Semi-structured interviews were conducted with eight Black cisgender women in Jackson, Mississippi. This sample was purposively recruited to include PrEP-initiated Black cisgender women. RESULTS: Six themes identified that shaped PrEP care among Black cisgender women: (1) internal assets, (2) sole responsibility to HIV prevention, (3) added protection in HIV serodifferent relationships, (4) financial issues, (5) trust and distrust in the medical system, and (6) side effects. Black cisgender women reported that PrEP persistence increased control over their sexual health, reduced anxiety about HIV, and promoted self-care. Black cisgender women also indicated that medication assistance programs increased PrEP affordability resulting in continued persistence. CONCLUSIONS: In addition to preventing HIV, PrEP may yield secondary positive impacts on the health and relationships of Black cisgender women. However, very few Black cisgender women in the South are using PrEP given intersectional barriers and thus necessitates adaptive strategies to support PrEP initiation and persistence. Efforts aimed at increasing the coverage of PrEP among Black cisgender women should consider implementation strategies responsive to lived realities of Black women.
