Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, Illinois, United States of America.
Department of Psychology, College of Health Professions, Rosalind Franklin University, North Chicago, Illinois, United States of America.
PLoS One. 2022 Jul 1;17(7):e0270861. doi: 10.1371/journal.pone.0270861. eCollection 2022.
Daily pre-exposure prophylaxis (PrEP) for HIV-prevention is an essential component of national plans to end the HIV epidemic. Despite its well-documented safety and effectiveness, PrEP prescription has not met the public health need. Significant disparities between White and Black people exist with respect to PrEP prescription, as do disparities between men and women. One factor contributing to these disparities is clinicians' assumptions about patients seeking PrEP.
The present study sought to investigate medical students' assumptions about patients seeking PrEP (anticipated increased condomless sex, extra-relational sex, and adherence to PrEP), and assumed HIV risk when presenting with their sexual partner. We systematically varied the race (Black or White) and gender (man or woman) of a fictional patient and their sexual partner. All were in serodifferent relationships including men who have sex with men (MSM), women (MSW), and women who have sex with men (WSM). Participants also completed an implicit association test measuring implicit racism against Black people. We evaluated the moderation effects of patient and partner race on assumptions as well as the moderated moderation effects of implicit racism.
A total of 1,472 students participated. For MSM patients, having a Black partner was associated with higher assumed patient non-adherence to PrEP compared to a White partner, however a White partner was associated with higher assumed HIV risk. For MSW patients, a White male patient was viewed as being more likely to engage in more extra-relational sex compared to a Black male patient. For WSM patients, White women were assumed to be more likely to have condomless and extra-relational sex, be nonadherent to PrEP, and were at higher HIV risk. Overall, implicit racism was not related to negative assumptions about Black patients as compared to White patients based on patient/partner race.
Medical education about PrEP for HIV prevention must ensure future health professionals understand the full range of patients who are at risk for HIV, as well as how implicit racial biases may affect assumptions about patients in serodifferent couples seeking PrEP for HIV prevention. As gatekeepers for PrEP prescription, clinicians' assumptions about patients seeking PrEP represent a barrier to access. Consistent with prior research, we identified minimal effects of race and implicit racism in an experimental setting.
每日暴露前预防（PrEP）是终结艾滋病流行的国家计划中的一个重要组成部分。尽管 PrEP 的安全性和有效性已得到充分证明，但 PrEP 的处方并未满足公共卫生需求。在 PrEP 处方方面，白人和黑人之间存在显著差异，男性和女性之间也存在差异。导致这些差异的一个因素是临床医生对寻求 PrEP 的患者的假设。
本研究旨在调查医学生对寻求 PrEP 的患者的假设（预期增加无保护性行为、额外性关系和 PrEP 依从性），以及在与性伴侣就诊时假设的 HIV 风险。我们系统地改变了虚构患者及其性伴侣的种族（黑人和白人）和性别（男性或女性）。所有患者均处于不同性别的关系中，包括男男性接触者（MSM）、女性（MSW）和女男性接触者（WSM）。参与者还完成了一项内隐联想测试，以衡量对黑人的内隐种族主义。我们评估了患者和伴侣种族对假设的调节作用，以及内隐种族主义的调节调节作用。
共有 1472 名学生参与了研究。对于 MSM 患者，与白人伴侣相比，黑人伴侣的 PrEP 不依从假设更高，但白人伴侣的 HIV 风险更高。对于 MSW 患者，与黑人男性患者相比，白人男性患者被认为更有可能发生更多的额外性关系。对于 WSM 患者，与黑人女性患者相比，白人女性患者被认为更有可能发生无保护性行为和额外性关系、不遵守 PrEP 以及 HIV 风险更高。总体而言，与基于患者/伴侣种族的黑人患者相比，内隐种族主义与对黑人患者的负面假设无关。
预防艾滋病毒的 PrEP 医学教育必须确保未来的卫生专业人员了解所有处于 HIV 风险中的患者，以及隐性种族偏见如何影响寻求 PrEP 预防 HIV 的不同性别伴侣中患者的假设。作为 PrEP 处方的把关人，临床医生对寻求 PrEP 的患者的假设代表了获得 PrEP 的障碍。与先前的研究一致，我们在实验环境中发现种族和内隐种族主义的影响很小。
