Photo Credit: Jelena Stanojkovic

In a study of PrEP use in Black sexual minority men, PrEP stigma was associated with a lower likelihood of current PrEP use in all models examined.

PrEP stigma was associated with more than a 2-fold decrease in PrEP use among Black sexual minority men (BSMM) after adjustment for age, according to findings published in AIDS and Behavior.

“This stigma is critical to address in PrEP promotion efforts, consistent with much of the literature on the negative effects of stigma,” wrote corresponding author Rodman Turpin, PhD, and study coauthors.

The study used an exploratory sequential mixed-methods approach to investigate whether PrEP-specific stigma was associated with reduced PrEP uptake among BSMM, a population disproportionately affected by HIV but with relatively low PrEP use. The study was informed by minority stress theory, which suggests adverse health outcomes are associated with societal marginalization based on characteristics related to identity.

Researchers analyzed cross-sectional data from a survey of 151 BSMM from the United States in late 2020. Among them, 57% identified as gay and 19.9% as bisexual.

Only a Quarter of BMSM Identified as PrEP Users

According to the study, 28.5% of BSMM surveyed reported using PrEP. The study team associated greater PrEP stigma, measured using the 10-item PrEP Stigma and Positive Attitudes scale, with less education, a lack of health insurance, greater depression, and not using PrEP.

PrEP stigma was associated with a lower likelihood of current PrEP use in all models, researchers reported. The fully adjusted prevalence ratio for PrEP use with PrEP stigma was 0.43.

To better clarify the relationship between PrEP stigma and PrEP use in BSMM, researchers conducted 15- to 25-minute qualitative interviews with 23 survey respondents starting in 2022. An analysis of their responses revealed a trio of major themes: sexual stigma specific to PrEP use (conflation of PrEP to hypersexuality or stigmatized forms of sex), intersections between PrEP and HIV stigma (concerns that onlookers might assume they have HIV if they access PrEP services at venues providing HIV care), and misinformation and disinformation about PrEP efficacy and side effects.

“Aligned with minority stress theory, each of these themes were based in part on stigma related to sex, sexuality, or race,” the researchers wrote. “Cultural competence towards BSMM communities, including both internal and external stigma reduction, are of great importance in PrEP promotion efforts.”