Healthcare Providers’ Biases May Be Preventing Black Women from Getting HIV PrEP

Black cisgender women have a disparately high rate of HIV infection, but they also have a high willingness to use preventative pre-exposure prophylaxis (PrEP). However, Black women are still drastically under-prescribed PrEP.

Healthcare providers often make clinical judgements about whom to prescribe PrEP, so a recent study published in the Journal of Acquired Immune Deficiency Syndrome sought to examine whether any unconscious or conscious bias was affecting their discretion.

“Despite their disparately high HIV incidence and their voiced willingness to use PrEP, Black women’s knowledge and uptake of PrEP are low, especially relative to white women and men who have sex with men (MSM),” said Shawnika J. Hull, PhD, the study’s lead author and an assistant professor at Rutgers School of Communication and Information.

The study consisted of an online experiment among 160 primary healthcare providers in 48 HIV hotspot countries. Using the Qualtrics research platform, the investigators gave the providers 1 of 4 profiles of a PrEP eligible woman, with the hypothetical women varying by race (Black/white) and substance use status (recent/none).

The study tested 2 models to predict providers’ (1) willingness to discuss PrEP with the hypothetical woman, and (2) willingness to prescribe PrEP to the hypothetical woman, in conjunction with racial biases. Providers who scored high for modern racism were less willing to discuss and prescribe PrEP to the Black woman in the experiment.

Even though healthcare providers know Black women are in need of PrEP, many held off due to unconscious bias and stereotyping about Black women’s behavior. The results showed that most of the bias was surrounding PrEP adherence, specifically the notion that Black women could not or would not take the once-daily medication. “PHCP [primary healthcare providers] may make judgements about who is a good candidate for PrEP that are based on conscious and nonconscious stereotypes and prejudice that disadvantage women, drug users, the poor, and Black people,” said Hull.

Hull and fellow investigators concluded that the study shows how vital it is to examine PrEP disparities through an intersectional lens. They recommended interventions among primary healthcare providers to address and remedy implicit biases that may be preventing minority communities from receiving lifesaving care.