Patterns of Sex and PrEP in Harlem MSM: A qualitative study (HPTN 067) - PowerPoint Presentation

Patterns of Sex and PrEP in Harlem MSM: A qualitative study (HPTN 067)  1. ICAP, Columbia University Mailman School of Public Health, New York, New York, United States 2. Department of Epidemiology, ICAP, Columbia University Mailman School of Public Health, New York, New York, United States 3. Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, United States 4. FHI 360, Durham, North Carolina, United States 5. Fred Hutchinson Cancer Research Center, Seattle, Washington, United States 6. Gladstone Institutes, University of California, San Francisco, California, United States 7. Department of Medicine, Harlem Hospital Center, New York, New York, United States Julie Franks 1 , Yael Hirsch-Moverman 1,2 , Avelino S. Loquere Jr 1 , K. Rivet Amico 3 , Bonnie J. Dye 4 , Laura McKinstry 5 , Robert M. Grant 6 , Sharon B. Mannheimer 7,1,2

Data Collection 6 Focus Groups (FG)6 In-depth Interviews (IDI)2 FG and 2 IDI per armSemi-structured guides explored experiences with PrEPSocial interactions about PrEPA dherence challenges Qualitative Sub-Study in Harlem FG(n=31)IDI(n=6)Total(n=37)Median age (years)343634Gender identity MSM TGW100%083%17%97%3%Race Black White Asian Other68%10%10%13%67%17%017%68%11%8%14%Hispanic ethnicity29%17%27%Unemployed65%83%68% Qualitative Sample Demographic Characteristics No significant demographic differences between qualitative and other study participants (data not shown)

Verbatim transcripts coded and analyzed using the constant comparative methodCoded excerpts were categorized as themes corresponding to domains of our qualitative research questionsData Analysis

The Value of PrEP Theme Illustrative Quotes Arm Wonder drugYes, this is a wonder drug. DI used to call that the Superman pill.TAlleviation of anxietyI was protected. Like that was my older brother and I was getting beat up by the bully at school. TPrevention AwarenessTaking the pill continually reminded me to protect myself from HIV. E Combination prevention Everybody . . . should use both, condoms and PrEP. People who use condoms shouldn’t be opposed to PrEP and people who use PrEP shouldn’t be opposed to using condoms. T

HIV-related Stigma Attributed to PrEP Use Theme Illustrative Quotes Arm HIV-related stigma Even if I told them it was just a study, maybe some of them wouldn’t believe it, and put some ideas into people’s heads that I did have HIV. TThat stigma - AIDS. You telling them you’re taking a pill to prevent it; they thinking you taking a pill to stop it. E

Promiscuity-related Stigma Attributed to PrEP Use Theme Illustrative Quotes Arm Promiscuity-related stigmaOne of my partners was like, “Whoa. What does this mean? What are you doing?” Indicating that taking the pill means that I’m willy-nilly having unprotected sex.DA few of them were just like – “I’d rather not have sex with you because I don’t know if PrEP works,” or “You’re probably just like a big whore.”D

Countering Stigma around PrEP Theme Illustrative Quotes Arm Doctors questionMy primary care doctor was opposed to it, . . . she said, “You don’t have HIV, why do you want this?” But I explained to her.DFamily questionsMy aunt said, “Wait, why are you in the study? Like are you HIV positive?” I said, “No, I’m not. I’m just joining the study because I want it to succeed, because then people won’t get HIV.”TFriends question They thought the only reason you’re on it is because you have HIV, and I asked, “Should I give my results to the HIV [test]?D

Stigma and Adherence to PrEP Theme Illustrative Quotes Arm Pills and sex don’t mixI would think [taking pills during sex] may also spoil the mood. And maybe make the other person, especially if they are not on the pill, so to speak, maybe even feel a little bit awkward. DPartners questionMy partners would be like, “Why are you taking those pills?” [and] sometimes it would never get to the intercourse part. It would just stop the night. They would be mad and leave.ENeed to be discreetIf you got a steady partner you know when you are going to do it or not. You can have [the pill]; ‘Hold on, let me go to the bathroom’ - pop it. Because . . . some people are not ready to just accept things. They live in - - in a fantasy world where you don’t think it can happen to youE

Summary Our qualitative sample of mostly Black MSM valued PrEP as a significant improvement over existing HIV prevention strategies Participants described strengthening their existing HIV prevention strategies by incorporating PrEPDisclosing PREP use led to stigmatizing attributions as either HIV-infected or as sexually promiscuous Anticipated or experienced stigma created barriers to adherence to sex-dependent doses

Qualitative sub-study recruited a convenience sample; not representative of all study participants or PrEP users Social desirability bias may have limited participants’ willingness to share some experiences and opinions in setting of FG and IDI Limitations

Study highlights need for community-level education to build social support for taking PrEPInterventions to address HIV-related stigma in the context of PrEP use are needed for Black MSM in the US Conclusions

“It’s just freedom. I feel like my entire life I’ve never, ever been free and now I do feel a certain amount of freedom.” - Daily arm IDI, 57 years oldPoster TULBPE21 July 21st, 2015

The HPTN 067 Harlem Qualitative Sub-Study Team acknowledges:Our participantsStudy staff at Harlem Prevention Center and Bronx Prevention Center Harlem Hospital Infectious Disease Community Advisory BoardThe Harlem CommunityHPTN Leadership and Operations CenterHPTN Statistical and Data Management Center