Despite its approval in 2012, uptake of Truvada, HIV (PrEP), is low among Black women although Black women face a higher burden of new HIV diagnoses. PrEP use is ideal for sexual risk behaviors including condom less sex, multiple sex partners, recent STI, HIV positive sexual partner, and commercial sex. Additionally, barriers to PrEP uptake among this population exist at the individual, interpersonal, community, and structural level. To better understand PrEP uptake among Black women, we systematically reviewed studies that addressed facilitators, and barriers to PrEP uptake among this population in order to understand its impact on sexual health decision making and HIV prevention outcomes.
The primary research questions guiding the review were as follows:
- What are the barriers of PrEP acceptability among HIV negative Black women?
- What are the facilitators of PrEP acceptability among HIV negative Black women?
We conducted a systematic review consistent with PRISMA (Preferred Reporting Items for Systematic Review) guidelines. After consulting with a health sciences librarian, we searched scholarly journal databases in November 2019, using a robust search string for articles reporting on PrEP acceptability among Black HIV-negative women in the United States between the years 2010 and 2020. Electronic databases included: Medline (Ovid); PsycINFO (Ovid); ClinicalTrials.gov; Cochrane Library (Wiley); Google Scholar. Articles included in this review met the following inclusion criteria: (1) U.S.-based study, (2) published in a peer-reviewed journal after 2010; (3) written in English; (4) cisgender Black HIV-negative women ages 18 and older, (5) PrEP knowledge/awareness, PrEP acceptability, PrEP use, (6) Studies with qualitative, quantitative, or mixed methods data analysis, (7) Pre-experimental, quasi-, and RCT designs. We also identified additional articles through reference harvesting, hand searching, and forward citation chaining.
The majority of studies utilized quantitative research design, followed by qualitative, and mixed methods. Studies focused on individual efficacy, but one study utilized dyads. The most common modes of PrEP delivery were oral PrEP, intravaginal PrEP, and microbicide gel. Included studies examined psychosocial factors such as history of physical violence, sexual violence, incarceration, and self-perception of HIV risk. Barriers to PrEP uptake included: low PrEP awareness, health care providers’ lack of prescribing PrEP, misinformation about PrEP eligibility and appropriateness, PrEP side effects, compliance requirements, mistrust in the government and pharmaceutical industry, support for the use of other HIV prevention strategies, and provider mistrust. Facilitators included learning about PrEP through trusted sources, and positive interactions with PrEP providers.
The results revealed consistent findings about structural barriers to PrEP willingness and uptake. Many Black women were unaware of PrEP as a method to prevent HIV infection. This review highlights the need for culturally relevant behavioral interventions to reduce barriers to PrEP uptake among Black women. This review concludes that public health social workers should advocate for more equitable and inclusive programs and practices to improve competency in provision of PrEP care within Black communities.