Sims Haynes Alexis, Markham Christine, Schick Vanessa, Suchting Robert, Parthasarathy Nivedhitha, Choudhury Sumaita, Hill Mandy J
Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth Houston, 1200 Pressler St, Houston, TX, 77030, USA.
Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth Houston, 1200 Pressler St, Houston, TX, 77030, USA.
AIDS Behav. 2025 Jan;29(1):101-132. doi: 10.1007/s10461-024-04491-z. Epub 2024 Sep 28.
Pre-exposure prophylaxis (PrEP) can significantly reduce human immunodeficiency virus (HIV) transmission among Black women in the United States (U.S.), a group disproportionately affected by HIV. However, PrEP uptake in this HIV-vulnerable population is low. This review analyzes the factors influencing Black women's PrEP willingness using the Behavioral Model for Vulnerable Populations (BMVP). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Population, Intervention, Comparison, Outcome, Study Design (PICOS) framework, we conducted a systematic literature search and selected 24 peer-reviewed studies on PrEP willingness. Narrative synthesis revealed a heterogeneous landscape of the determinants affecting PrEP willingness among Black women, categorized into three main domains. Predisposing demographic and social factors included younger age, unmarried status, higher education, sexual or gender minority identity, trust in healthcare providers, and perceived HIV risk. Predisposing behavioral factors included condomless sex, multiple partners, and engagement in sex work. Socioeconomic status, health insurance, healthcare access, support systems, and structural challenges were identified as enabling factors influencing Black women's PrEP willingness. Finally, the perceived need domain and health-related factors influencing the perceived need for PrEP included a history of sexually transmitted infections (STI), intimate partner violence (IPV), and birth control interference. This study emphasizes the complexity of the barriers and facilitators of PrEP uptake and, thus, the need for tailored interventions and health strategies to promote its use. Addressing the interconnected individual, interpersonal, and structural determinants of PrEP access is crucial for improving PrEP willingness and thereby advancing health equity in this population.
暴露前预防（PrEP）可显著降低美国黑人女性中的人类免疫缺陷病毒（HIV）传播，该群体受HIV影响的比例过高。然而，这一HIV易感人群中PrEP的使用率较低。本综述使用弱势群体行为模型（BMVP）分析影响黑人女性PrEP意愿的因素。遵循系统评价和Meta分析的首选报告项目（PRISMA）指南以及人群、干预措施、对照、结局、研究设计（PICOS）框架，我们进行了系统的文献检索，并选择了24项关于PrEP意愿的同行评审研究。叙述性综合分析揭示了影响黑人女性PrEP意愿的决定因素呈现出异质性，分为三个主要领域。易患的人口统计学和社会因素包括年龄较小、未婚、高等教育、性少数或性别少数身份、对医疗服务提供者的信任以及感知到的HIV风险。易患的行为因素包括无保护性行为、多个性伴侣以及从事性工作。社会经济地位、医疗保险、医疗服务可及性、支持系统和结构性挑战被确定为影响黑人女性PrEP意愿的促成因素。最后，感知需求领域以及影响PrEP感知需求的健康相关因素包括性传播感染（STI）病史、亲密伴侣暴力（IPV）和节育干扰。本研究强调了PrEP使用的障碍和促进因素的复杂性，因此需要量身定制的干预措施和健康策略来促进其使用。解决PrEP获取中相互关联的个人、人际和结构决定因素对于提高PrEP意愿从而促进该人群的健康公平至关重要。
