Understanding, Contextualizing, and Addressing PrEP Stigma to Enhance PrEP Implementation
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IMPLEMENTATION SCIENCE (E GENG, SECTION EDITOR)
Understanding, Contextualizing, and Addressing PrEP Stigma to Enhance PrEP Implementation Sarah K. Calabrese 1,2 Accepted: 4 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review HIV pre-exposure prophylaxis (PrEP) is a safe and effective preventive intervention that could play a central role in ending the HIV epidemic. However, low uptake in general, and among certain social groups in particular, underscores the need to identify and address barriers to PrEP use. PrEP stigma has emerged as a key factor interfering with PrEP interest, uptake, and continuation. The purpose of this article is to describe and contextualize PrEP stigma and to offer recommendations on how to address it in future PrEP implementation initiatives. Recent Findings PrEP users are commonly stereotyped as sexually irresponsible, promiscuous, and immoral. These stereotypes and associated prejudice manifest at multiple levels and discourage PrEP interest and uptake, disrupt PrEP adherence, and motivate PrEP discontinuation. Intersecting forms of stigma may influence the nature, magnitude, and impact of PrEP stigma across social groups and otherwise hinder PrEP use. Current PrEP implementation strategies that narrowly focus on risk and target stigmatized groups with disproportionately high HIV incidence have yielded limited success and are counterproductive to the extent that they perpetuate stigma. Implementation strategies involving more inclusive messaging and further integration of PrEP within healthcare may help to reduce PrEP stigma and mitigate its impact, ultimately increasing PrEP use. Summary PrEP stigma is a barrier to PrEP interest, uptake, and continuation that manifests at multiple levels. Understanding and addressing PrEP stigma requires consideration of its origins and intersections. Targeted, risk-focused implementation strategies perpetuate stigma and undermine use. Keywords HIV . Pre-exposure prophylaxis (PrEP) . Stigma . Disparities
Introduction HIV pre-exposure prophylaxis (PrEP) is a remarkably effective evidence-based intervention with the potential to dramatically alter the course of the HIV epidemic on a national and global scale. In the decade since the results of the groundbreaking iPrEx trial were first released, much progress has been made in the way of implementing PrEP: PrEP programs This article is part of the Topical Collection on Implementation Science * Sarah K. Calabrese [email protected] 1
Department of Psychological and Brain Sciences, The George Washington University, 2125 G Street NW, Washington, DC 20052, USA
2
Department of Prevention and Community Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC 20052, USA
exist in at least 65 countries worldwide, with an estimated 663,000 cumulative PrEP initiations globally, including over 200,000 in the USA alone [1]. Despite these successes, the number of current PrEP users constitutes only a fraction of the population
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