Perceived Social Norms About Oral PrEP Use: Differences Between African–American, Latino and White Gay, Bisexual and Other Men Who Have Sex with Men in Texas

  • Phillip W. Schnarrs
  • Danielle Gordon
  • Ryan Martin-Valenzuela
  • Thankam Sunil
  • Adolph J. Delgado
  • David Glidden
  • Jeffrey T. Parsons
  • Joe McAdams
Original Paper

Abstract

Correct and consistent condom use has been the primary method of HIV prevention until the FDA approve the use of PrEP in 2012. While strong evidence existing regarding the efficacy of PrEP, uptake has remained slower than anticipated. While work is underway to better understand the factors impacting uptake, the majority of this work as been focused on white gay, bisexual, and other men who have sex with men (GBMSM) living in metropolitan regions of the coastal U.S. The current study used a community-based framework to assess perceived social norms through a elicitation survey. A total of 104 GBMSM met inclusion criteria for the study. Several analytic categories emerged across questions and a number of differences were found across race and ethnicity such as who would approve or disapprove off PrEP and who would be likely to use PrEP. Further, we found differences between injunctive and descriptive norms. These findings suggest that there are unique factors contributing to PrEP uptake among racial and ethnic minority GBMSM and that to fully understand uptake a more robust measure of perceived norms may be needed.

Keywords

HIV/AIDS MSM Gay and bisexual men Pre-exposure prophylaxis Perceived social norms Racial and ethnic minority Latino/hispanic 

References

  1. 1.
    Hall IH, An Q, Tang T, et al. Prevalence of diagnosed and undiagnosed HIV infection—United States, 2008–2012. MMRW. 2015;64(24):657–62.Google Scholar
  2. 2.
    Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2014. HIV Surveillance Supplemental Report 2016; 21(4). http://www.cdc.gov/hiv/library/reports/surveillance/. Published July 2016. Accessed 17 July 2017.
  3. 3.
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2015; vol. 27. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published November 2016. Accessed 17 July 2017.
  4. 4.
    USFDA. FDA approves first drug for reducing the risk of sexually acquired HIV infection. 2012.Google Scholar
  5. 5.
    Centers for Disease Control and Prevention. Pre-exposure prophylaxis for the prevention of HIV infection in the United States—2014: a clinical practice guidelines. Washington, DC: U.S. Public Health Service; 2014.Google Scholar
  6. 6.
    Anderson PL, Glidden DV, Liu A, Buchbinder S, Lama JR, Guanira JV, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med. 2012;4:151ra125.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Donnell D, Baeten JM, Bumpus N, et al. HIV protective efficacy and correlates of tenofovir blood concentrations in a clinical trial of PrEP for HIV prevention. JAIDS. 2014;66(3):340–8.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Spinner CD, Boesecke C, Zink A, et al. HIV pre-exposure prophylaxis (PrEP): a review of current knowledge of oral systemic HIV PrEP in humans. Infection. 2016;44(2):151–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Volk JE, Marcus JL, Phengrasamy T, Blechinger D, Nguyen DP, Follansbee S, et al. No new HIV infections with increasing use of HIV preexposure prophylaxis in a clinical practice setting. Clin Infect Dis. 2015;61:1601–3.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Liu A, Cohen S, Follansbee S, et al. Early experiences implementing pre-exposure prophylaxis (PrEP) for HIV prevention in San Francisco. PLoS. 2014.  https://doi.org/10.1371/journal.pmed.1001613.Google Scholar
  11. 11.
    Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363:2587–99.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Mera R, McCallister S, Palmer B, et al. Truvada (TVD) for HIV pre-exposure prophylaxis (PrEP) utilization in the United States (2013–2015). In: 21st international AIDS conference 2016, Durban, South Africa, Abstract TUAX0105LB.Google Scholar
  13. 13.
    Kirby T, Thornber-Dunwell M. Uptake of PrEP slow among MSM. Lancet. 2014;383(9915):399–400.CrossRefPubMedGoogle Scholar
  14. 14.
    Sullivan PS, Carballo-Dieguez A, Coates T, et al. Successes and challenges of HIV prevention in men who have sex with men. Lancet. 2012;380:388–99.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Parsons JT, Rendia HJ, Lassister JM. Uptake of HIV pre-exposure prophylaxis (PrEP) in a national cohort of gay and bisexual men in the United States: The motivation PrEP cascade. JAIDS. 2017.  https://doi.org/10.1097/qai.0000000000001251.PubMedCentralGoogle Scholar
  16. 16.
    Arrington-Sanders R, Morgan A, Oidtman J, Qian I, Celentano D, Beyrer C. A medical care missed opportunity: preexposure prophylaxis and young black men who have sex with men. J Adolesc Health. 2016;59(6):725–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Lelutiu-Weinberger C, Golub SA. Enhancing PrEP access for black and latino men who have sex with men. JAIDS. 2016;73(5):547–55.  https://doi.org/10.1097/qai.0000000000001140.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Snowden JM, Chen Y-H, Mcfarland W, Raymond HF. Prevalence and characteristics of users of pre-exposure prophylaxis (PrEP) among men who have sex with men, San Francisco, 2014 in a cross-sectional survey: implications for disparities. Sex Transm Infect. 2016;93(1):52–5.  https://doi.org/10.1136/sextrans-2015-052382.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Gamarel KE, Golub SA. Intimacy motivations and pre-exposure prophylaxis (PrEP) adoptionintentions among HIV-negative men who have sex with men (MSM) in romantic relationships. Ann Behav Med. 2014;49:177–86.CrossRefGoogle Scholar
  20. 20.
    Millett GA, Peterson JL, Flores SA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK and USA: a meta-analysis. The Lancent. 2012;380(9839):341–8.CrossRefGoogle Scholar
  21. 21.
    Pulsipher CA, Montoya JA, Plant A, et al. Addressing PrEP disparities among young gay and bisexual men in California. California HIV/AIDS Research Program. 2016.Google Scholar
  22. 22.
    Aghaizu A, Mercey D, Copas A, Johnson AM, Hart G, Nardone A. Who would use PrEP? Factors associated with intention to use among MSM in London: a community survey. Sex Transm Infect. 2013;89:207–11.CrossRefPubMedGoogle Scholar
  23. 23.
    Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDs. 2013;27:248–54.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Grov C, Whitfield TH, Rendina HJ, Ventuneac A, Parsons JT. Willingness to take PrEP and potential for risk compensation among highly sexually active gay and bisexual men. AIDS Behav. 2015;19:1–11.CrossRefGoogle Scholar
  25. 25.
    Barash EA, Golden M. Awareness and use of HIV pre-exposure prophylaxis among attendees of a Seattle gay pride event and sexually transmitted disease clinic. AIDS Patient Care STDs. 2010;24:689–91.CrossRefPubMedGoogle Scholar
  26. 26.
    Grov C, Rendia HJ, Whitfield THF, et al. Changes in familiarity and willingness to take pre-exposure prophylaxis in a longitudinal stufy of highly sexually active gay and bisexual men. LGBT Health. 2016.  https://doi.org/10.1089/lgbt.2015.0123.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Holt M, Murphy DA, Callander D, Ellard J, Rosengarten M, Kippax SC, et al. Willingness to use HIV pre-exposure prophylaxis and the likelihood of decreased condom use are both associated with unprotected anal intercourse and the perceived likelihood of becoming HIV positive among Australian gay and bisexual men. Sex Transm Infect. 2012;88:258–63.CrossRefPubMedGoogle Scholar
  28. 28.
    Rendia HJ, Whitfield THF, Grov C, et al. Distinguishing hypothetical willingness from behavioral intentions to initiate HIV pre-exposure prophylaxis (PrEP): findings from a large cohort of gay and bisexual men in the U.S. Soc Sci Med. 2017;172:115–23.CrossRefGoogle Scholar
  29. 29.
    Stringer KL, Turan B, McCormick L, et al. HIV-related stigma among health care providers in the Deep South. AIDS Behav. 2016;20(1):115–25.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Reif S, Pence BW, Hall I, et al. HIV diagnoses, prevalence and outcomes in nine southern states. J Commun Health. 2015;40(4):642–51.CrossRefGoogle Scholar
  31. 31.
    Mansergh G, Koblin BA, Sullivan PS. Challenges for HIV pre-exposure prophylaxis among men who have sex with men in the United States. PLoS. 2012.  https://doi.org/10.1371/journal.pmed.1001286.Google Scholar
  32. 32.
    Sanchez T, S C, Kelley C, O’Hara B, Frew P, Peterson J, del Rio C, Sullivan P. Perceptions of HIV pre-exposure prophylaxis use vary among white and black men who have sex with men. In: 7th IAS conference on HIV pathogenesis, treatment and prevention, Kuala Lumpur, Malaysia. 2013.Google Scholar
  33. 33.
    Bauermeister J, Meanley S, Pingel E, Soler J, Harper G. PrEP awareness and perceived barriers among single young men who have sex with men. Curr HIV Res. 2014;11(7):520–7.  https://doi.org/10.2174/1570162x12666140129100411.CrossRefGoogle Scholar
  34. 34.
    Kelley CF, Kahle E, Siegler A, et al. Applying a PrEP continuum of care for men who have sex with men in Atlanta, Georgia. Clin Infect Dis. 2015;61(10):1590–7.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson D, Mayer KH. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care. 2017.  https://doi.org/10.1080/09540121.2017.1300633.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Smith DK, Toledo L, Smith DJ, Adams MA, Rothenberg R. Attitudes and program preferences of African-American urban young adults about pre-exposure prophylaxis (PrEP). AIDS Educ Prev. 2012;24(5):408–21.  https://doi.org/10.1521/aeap.2012.24.5.408.CrossRefPubMedGoogle Scholar
  37. 37.
    Levy ME, Wilton L, Phillips G, et al. Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States. AIDS Behav. 2014;18(5):972–96.  https://doi.org/10.1007/s10461-014-0719-x.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Eaton LA, Driffin DD, Bauermeister J, et al. Minimal awareness and stalled uptake of pre-exposure prophylaxis (PrEP) among at risk, HIV-negative, black men who have sex with men. AIDS Patient Care STDs. 2015;29(8):423–9.  https://doi.org/10.1089/apc.2014.0303.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Calabrese SK, Earnshaw VA, Underhill K, et al. The impact of patient race on clinical decisions related to prescribing HIV pre-exposure prophylaxis (PrEP): assumptions about sexual risk compensation and implications to access. AIDS Behav. 2014;18(2):226–40.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Martinez O, Wu E, Levine EC, et al. Integration of social, cultural, and biomedical strategies into an existing couple-based behavioral HIV/STI prevention intervention: voices of latino male couples. PLoS ONE. 2016.  https://doi.org/10.1371/journal.pone.0152361.Google Scholar
  41. 41.
    Azjen I. Constructing a TPB questionnaire: conceptual and methodological considerations. 2002.Google Scholar
  42. 42.
    Azjen I. The theory of planned behavior. Org Behav Hum Decis Processes. 1991;50:179–211.CrossRefGoogle Scholar
  43. 43.
    Steinmetz H, Knappstein M, Azjen I, et al. How effective are behavior change interventions based on the theory of planned behavior?: A three-level meta-analysis. Zeitschrift für Psychologie. 2018;224:216–33.  https://doi.org/10.1027/2151-2604/a000255.CrossRefGoogle Scholar
  44. 44.
    Sniehotta FF, Presseau J, Araújo-Soares V. Time to retire the theory of planned behaviour. Health Psychol Rev. 2013;8:1–7.CrossRefGoogle Scholar
  45. 45.
    Azjen I. The theory of planned behavior is alive and well, and not ready to retire: a commentary on Sniehotta, Presseau and Araújo-Soares. Health Psychol Rev. 2014.  https://doi.org/10.1080/17437199.2014.883474.Google Scholar
  46. 46.
    Andrew BJ, Mullan BA, de Wit JBF, et al. Does the theory of planned behaviour explain condom use behaviour among men who have sex with men? A meta-analytic review of the literature. AIDS Behav. 2016.  https://doi.org/10.1007/s10461-016-1314-0.PubMedCentralGoogle Scholar
  47. 47.
    Vissman AT, Hergenrather KC, Rojas G, et al. Applying the theory of planned behavior to explore HAART adherence among HIV-positive immigrant Latinos: elicitation interview results. Patient Educ Couns. 2011;85(3):454–60.CrossRefPubMedGoogle Scholar
  48. 48.
    Morris MW, Hong Y, Chiu C, et al. Normology: integrating insights about social norms to understand cultural dynamics. Org Behav Hum Decis Processes. 2015;129:1–13.CrossRefGoogle Scholar
  49. 49.
    Knight-Lapinski M, Rimal RN. An explication of social norms. Commun Theory. 2005;15(2):127–47.CrossRefGoogle Scholar
  50. 50.
    Lynn M, Brewster ZW. Racial and ethnic differences in tipping. Cornell Hosp Q. 2014;56(1):68–79.CrossRefGoogle Scholar
  51. 51.
    Qualtrics (online database management software). Provo, UT: Qualtrics; 2017.Google Scholar
  52. 52.
    Morgan DL. Qualitative content analysis: a guide to paths not taken. Qual Health Res. 1993;3(1):112–21.CrossRefPubMedGoogle Scholar
  53. 53.
    Hsieh HF, Shannon SE. Three approaches to content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRefPubMedGoogle Scholar
  54. 54.
    Forman J, Damschroder L. Qualitative content analysis. In: Jacoby L, Siminoff LA, editors. Empirical methods for bioethics: a primer, vol. 11. Oxford: Elesvier, Ltd.; 2008. p. 39–62.CrossRefGoogle Scholar
  55. 55.
    Perez KG, Cruess D. The impact of familism on physical and mental health among Hispanics in the United States. Health Psychol Rev. 2014;8(1):95–127.CrossRefGoogle Scholar
  56. 56.
    Levin JS, Taylor RJ, Chatters LM. Race and gender differences in religiosity among older adults: findings from four national surveys. J Gerontol. 1994;49(3):S137–45.CrossRefPubMedGoogle Scholar
  57. 57.
    Taylor RJ, Chatters LM, Jayakody R, Levin JS. Black and white differences in religious participation: a multisample comparison. J Sci Study Relig. 1996;35(4):403–10.CrossRefGoogle Scholar
  58. 58.
    Garcia G, Ellison CG, Sunil TS, et al. Religion and selected health behaviors among Latinos in Texas. J Relig Health. 2013;52(1):18–31.CrossRefPubMedGoogle Scholar
  59. 59.
    Lambert D, Schipani-McLaughlin AM, Norelli J, et al. Sex education in churches: African-American church leader’s perceptions of acceptable sex education content for faith-based settings. In: Presented at the American Public Health Association 144th Annual Meeting: Denver, CO. 2016.Google Scholar
  60. 60.
    Mayer KH, Krakower DS. If PrEP decreases HIV transmission, what is impeding uptake? Clin Infect Dis. 2015;61:1598Á600.Google Scholar
  61. 61.
    Philbin MM, Parker CM, Parker RG, Wilson PA, Garcia J, Hirsch JS. The promise of pre-exposure prophylaxis for black men who have sex with men: an ecological approach to attitudes, beliefs, and barriers. AIDS Patient Care STDs. 2016;30(6):282–90.  https://doi.org/10.1089/apc.2016.0037.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Eaton LA, Kalichman SC, Price D, Finneran S, Allen A, Maksut J. 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. AIDS Behav. 2017;21(5):1236–46.  https://doi.org/10.1007/s10461-017-1690-0.CrossRefPubMedGoogle Scholar
  63. 63.
    Blumenthal J, Haubrich R. Risk compensation in PrEP: an old debate emerges yet again. VM. 2014;16(11):909–15.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Kinesiology, Health and Nutrition, College of Education and Human DevelopmentThe University of Texas at San Antonio, One UTSA CircleSan AntonioUSA
  2. 2.The South Texas Consortium for HIV and STI ResearchSan AntonioUSA
  3. 3.Department of Epidemiology, Human Genetics and Environmental SciencesThe University of Texas School of Public HealthSan AntonioUSA
  4. 4.Department of SociologyThe University of Texas at San AntonioSan AntonioUSA
  5. 5.Institute for Health Disparities ResearchThe University of Texas at San AntonioSan AntonioUSA
  6. 6.San Antonio AIDS FoundationSan AntonioUSA
  7. 7.Department of EpidemiologyThe University of California San FranciscoSan FranciscoUSA
  8. 8.Center for HIV Educational Studies and TrainingNew YorkUSA
  9. 9.Department of PsychologyHunter CollegeNew YorkUSA
  10. 10.Austin PrEP Access ProjectAustinUSA

Personalised recommendations