title: The impact of patient race on clinical decisions related to prescribing HIV pre-exposure prophylaxis (PrEP): assumptions about sexual risk compensation and implications for access.
abstract: Antiretroviral pre-exposure prophylaxis (PrEP) has received increasing recognition as a viable prescription-based intervention for people at risk for HIV acquisition. However, little is known about racial biases affecting healthcare providers' willingness to prescribe PrEP. This investigation sought to explore medical students' stereotypes about sexual risk compensation among Black versus White men who have sex with men seeking PrEP, and the impact of such stereotypes on willingness to prescribe PrEP. An online survey presented participants (n = 102) with a clinical vignette of a PrEP-seeking, HIV-negative man with an HIV-positive male partner. Patient race was systematically manipulated. Participants reported predictions about patient sexual risk compensation, willingness to prescribe PrEP, and other clinical judgments. Bootstrapping analyses revealed that the Black patient was rated as more likely than the White patient to engage in increased unprotected sex if prescribed PrEP, which, in turn, was associated with reduced willingness to prescribe PrEP to the patient.
authors.affiliation: Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510, USA, sarah.calabrese@yale.edu.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Calabrese
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Earnshaw
authors.forename: Kristen
authors.initials: K
authors.lastname: Underhill
authors.forename: Nathan B
authors.initials: NB
authors.lastname: Hansen
authors.forename: John F
authors.initials: JF
authors.lastname: Dovidio
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001291:Attitude of Health Personnel; D044383:Black People / Q000706:statistics & numerical data; D054521:Cultural Competency; D003657:Decision Making; D011307:Drug Prescriptions; D015658:HIV Infections / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006297:Health Services Accessibility; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D011287:Prejudice; D063505:Racism; D012959:Socioeconomic Factors; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D044465:White People / Q000706:statistics & numerical data
chemical_list: D019380:Anti-HIV Agents