The Problem with PrEP: Intersectional Stigma and Modern HIV Prevention in the United States

Abstract

Even though the literature published on PrEP [Pre-Exposure Prophylaxis] is still relatively new, there has already been a lack of coherence between studies to understand which social mechanisms and individual factors underlie large disparities in use between white and black MSM. Studies will frequently focus solely on the consequences of stigma, correlates of healthcare access, or effects of medical mistrust without considering how these processes may feed into or interact with each other. To bridge this gap, my goal is to analyze a series of questions using the findings from selected studies to ascertain the ways in which various sociocultural and health factors, namely homophobic stigma, have been shown to shape PrEP usage patterns among white and black MSM. Such questions include: (1) Do greater degrees of homophobia within the black community mediate the lower propensity of black MSM to seek a PrEP prescription, and to what extent?; (2) Is there evidence of factors relating to healthcare access or medical mistrust that may interact with stigma to further shape PrEP usage patterns?; and (3) What measures and models should future studies pertaining to the racial disparities of PrEP highlight and address? By analyzing homophobic stigma alongside issues of healthcare access and medical mistrust, my hope is to contribute insights into the ways in which problematic social norms and stigma are operative in health-seeking behaviors that can reinforce and perpetuate HIV disparities within the United States. [From Introduction]