Medical Distrust and the Intention to Initiate Pre-Exposure Prophylaxis in Black Cisgender Women.

IF 3.4 2区 医学 Q2 INFECTIOUS DISEASES
Tami Alade, Shawnika Hull, Hannah Sinks, Jennifer Zack, Patricia Moriarty, Rachel K Scott
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Abstract

Black women bear a disproportionate burden of the US HIV epidemic, compared with women of other racial groups. Pre-exposure 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 communication and shared decision-making with health care providers. Using an institutional review board-approved questionnaire, we surveyed 186 adults (83% Black; 9% White; 3% American Indian/Alaskan Native; 4% Other) who were PrEP eligible, HIV seronegative, cisgender women 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 indicate significant moderated mediation of the interaction between race and distrust on intention to initiate PrEP at 3 months [index = -0.3093, standard error (SE) = 0.1886, 95% confidence interval (CI; -0.7455, -0.0122)] and 12 months [index = -0.3248, SE = 0.1987, 95% CI: (-0.7827, -0.0040)] through an anticipated discussion with a provider. 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. These results underscore the critical importance of provider-initiated discussion of PrEP with women to improve health equity. This study was limited by the low number of non-Black participants (17%) as well as the requirement that subjects be English-speaking only.

黑人顺性别妇女的医疗不信任与暴露前预防的意向
与其他种族妇女相比,黑人妇女在美国艾滋病毒流行中承担着不成比例的负担。暴露前预防(PrEP)是一种非常有效的预防工具。有证据表明,黑人妇女对开始使用PrEP感兴趣,但该人群的使用率仍然很低。有色人种女性遭受的历史虐待以及由此产生的不信任,为她们与医疗服务提供者的沟通和共同决策设置了障碍。使用机构审查委员会批准的问卷,我们调查了186名成年人(83%黑人;9%的白人;3%美国印第安人/阿拉斯加原住民;4%其他)符合PrEP条件,HIV血清阴性,华盛顿特区的顺性别妇女。我们测试了患者种族认同和基于群体的医疗不信任对使用PrEP意图的相互作用,在即将到来的临床互动中,与卫生保健提供者讨论PrEP的意图作为中介。结果表明,种族和不信任对3个月开始PrEP意向的交互作用具有显著的调节中介作用[指数= -0.3093,标准误差(SE) = 0.1886, 95%置信区间(CI);-0.7455, -0.0122)]和12个月[指数= -0.3248,SE = 0.1987, 95% CI:(-0.7827, -0.0040)]通过与供应商的预期讨论。当不信任感较低时,黑人妇女(相对于其他种族的妇女)使用PrEP的意愿更强。这可以解释为在临床访问期间与提供者讨论PrEP的强烈意图。这些结果强调了由提供者发起的与妇女讨论预防措施对改善健康公平的关键重要性。这项研究受到非黑人参与者数量较少(17%)以及受试者只会说英语的要求的限制。
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来源期刊
AIDS patient care and STDs
AIDS patient care and STDs 医学-传染病学
CiteScore
7.00
自引率
22.40%
发文量
67
审稿时长
6-12 weeks
期刊介绍: AIDS Patient Care and STDs is the foremost journal providing the latest developments and research in diagnostics and therapeutics designed to prolong the lifespan and improve quality of life for HIV/AIDS patients. The Journal delivers cutting-edge clinical, basic science, sociologic, and behavior-based investigations in HIV/AIDS and other sexually transmitted infections. Clinical trials, quantitative and qualitative analyses of pilot studies, comprehensive reviews, and case reports are presented from leading experts and scientists around the world. AIDS Patient Care and STDs coverage includes: Prominent AIDS medications, therapies, and antiretroviral agents HIV/AIDS-related diseases, infections, and complications Challenges of medication adherence Current prevention techniques for HIV The latest news and developments on other STDs Treatment/prevention options, including pre- and post-exposure prophylaxis
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