Pre-Exposure Prophylaxis Literacy Among Black and Latinx Patients Who Could Benefit from HIV Prevention Medication

Abstract

Introduction: Pre-Exposure Prophylaxis (PrEP) is only reaching a small percentage of people who could benefit from it. The disproportionate impact of HIV and lower rates of PrEP prescriptions for Black and Latinx patients is of crucial concern and must be addressed if the disease is ever to be eradicated. Primary Care Provider (PCP) communication strategies focused on increasing Sexual Health Practices Self-Efficacy (SHPSE) and understanding of one’s own sexual health needs when educating about HIV and PrEP will be a significant approach to reducing disparities among people of color.

Objective: Determine the influences of PrEP/HIV sources of information and SHPSE on level of PrEP literacy.

Methods: This study employed a cross-sectional study design to explore PrEP literacy. The survey was disseminated among Black and Latinx individuals in Indiana. A multivariate linear regression was conducted to determine the relationship of 2 independent variables: sources of HIV information and SHPSE, and 5 covariates: race/ethnicity, gender, PrEP indicators, sexual identification, and HIV standards of care, on the dependent variable: PrEP literacy. PrEP Literacy Scale contained 9 questions concerning common misconceptions about PrEP. Scores ranged from 9-18, with a score of 18 indicating a high degree of PrEP literacy. SHPSE was assessed using participants’ self-rated level of confidence in performing various sexual health practices on a scale from 1=no confidence to 4=high confidence.

Results: Participants (n=606) identified as Black (67.6%) and Latinx (32.4%). Women accounted for the majority (63.4%) of the sample, followed by men (35.5%). 83% of the sample identified as straight, while 1.8% and 10.1% identified as gay and bisexual. The regression model was significant (p<.001) and explained 22% of the variance in the dependent variable, PrEP literacy (R2=.223). Results indicate that participants who report a level 4 (p=.01) and level 3 (p=.02) SHPSE were more likely to have a higher PrEP literacy compared to respondents who report level 1 SHPSE. Latinx participants reported higher PrEP literacy compared with Black respondents (p=.02). Receiving annual HIV screenings was associated with a higher PrEP literacy (p=.002). Finally, using a PCP as the primary source of HIV information was associated with higher PrEP literacy (p=.01); conversely, using friends as the primary source of HIV information was associated with lower PrEP literacy (p<.001), which was the strongest predictor in the model (𝜷=-.238).

Conclusions: PrEP literacy is increased among patients reporting more contact with their provider, especially with PCPs who screen for HIV regularly. Respondents who utilize their PCPs are more confident accessing HIV services and are more able to discern fact from fiction around PrEP. PCPs who serve as a primary source of information may also serve as the patient’s sole, accurate source of sexual health education. Findings suggest that curricular changes should integrate a holistic education strategy around sexual health for healthcare providers, which entails taking a detailed sexual health history, assessing HIV risk factors, and determining when it is appropriate to prescribe PrEP.