Black men who have sex with men (MSM) in London experience a unique set of motivations and barriers to using pre-exposure prophylaxis (PrEP), according to the results of a recent qualitative study published in Sexually Transmitted Infections. This research was carried out by T. Charles Witzel and colleagues at the London School of Hygiene and Tropical Medicine.
Black MSM who had very mixed social groups in terms of sexual orientation and ethnicity tended to report limiting discussions about sexual health to their gay male friends. Racism and exclusion in both online and offline gay spaces were barriers to coming into contact with PrEP messaging. Stereotypical understandings of PrEP use intersected with racist ideals of black male sexuality, limiting self-identification as a potential PrEP user. On the other hand, some men viewed PrEP in a positive light as it was seen as a way of mitigating risk.
Black MSM in the UK have higher rates of HIV incidence and prevalence, despite similar risk profiles when compared to other MSM. A cross-sectional study showed that 2.8% of black MSM were diagnosed with HIV versus 1.1% of overall MSM in the preceding year.
Prior research identified prohibitive costs, lack of risk perception, unacceptable clinical services, concerns about side-effects and issues regarding stigma as the primary barriers to accessing PrEP for a range of MSM. Perception of high risk behaviour and the pleasure associated with condomless sex were important motivators when it came to men seeking out PrEP. Specifically for black MSM in London, factors such as preferred clinic locations outside their home communities and the skill and empathy of clinical staff were important.
Currently in England, PrEP is available to 13,000 participants enrolled in the IMPACT trial. During data collection for this qualitative study (2016), it had only been available to 550 participants enrolled in the PROUD trial. However, many MSM in the UK have accessed generic forms of PrEP from alternative sources, such as ordering it online.
Racism, marginalisation and PrEP stereotypes affect PrEP uptake for black MSM in London
Krishen Samuel
Published: 09 April 2019
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Black men who have sex with men (MSM) in London experience a unique set of motivations and barriers to using pre-exposure prophylaxis (PrEP), according to the results of a recent qualitative study published in Sexually Transmitted Infections. This research was carried out by T. Charles Witzel and colleagues at the London School of Hygiene and Tropical Medicine.
Black MSM who had very mixed social groups in terms of sexual orientation and ethnicity tended to report limiting discussions about sexual health to their gay male friends. Racism and exclusion in both online and offline gay spaces were barriers to coming into contact with PrEP messaging. Stereotypical understandings of PrEP use intersected with racist ideals of black male sexuality, limiting self-identification as a potential PrEP user. On the other hand, some men viewed PrEP in a positive light as it was seen as a way of mitigating risk.
Black MSM in the UK have higher rates of HIV incidence and prevalence, despite similar risk profiles when compared to other MSM. A cross-sectional study showed that 2.8% of black MSM were diagnosed with HIV versus 1.1% of overall MSM in the preceding year.
Prior research identified prohibitive costs, lack of risk perception, unacceptable clinical services, concerns about side-effects and issues regarding stigma as the primary barriers to accessing PrEP for a range of MSM. Perception of high risk behaviour and the pleasure associated with condomless sex were important motivators when it came to men seeking out PrEP. Specifically for black MSM in London, factors such as preferred clinic locations outside their home communities and the skill and empathy of clinical staff were important.
Currently in England, PrEP is available to 13,000 participants enrolled in the IMPACT trial. During data collection for this qualitative study (2016), it had only been available to 550 participants enrolled in the PROUD trial. However, many MSM in the UK have accessed generic forms of PrEP from alternative sources, such as ordering it online.
The study
Semi-structured face-to-face interviews were conducted with 25 black MSM aged 18-45 in London in 2016. Most men were of black African descent, with some of black Caribbean descent, while the remaining men were classified as ‘black British other’. The majority identified as gay, were university graduates and had tested for HIV in the past year.
Seventeen men had never accessed PrEP and were considered PrEP naïve; five men had used PrEP and three had been unable to access PrEP despite wanting to.
Thematic analysis of the interviews revealed the following.
PrEP-related knowledge, support and discussion
Conversations regarding sexual health and PrEP were made challenging due to the diversity of men’s social contacts and the intersection of ethnic background, family history and religion. This was most pronounced for those who were not out about their sexuality but was also expressed by men who were out.
This often meant that men could only have candid conversations about sex and sexual health with other gay and bisexual men. However, among gay and bisexual black men – especially the PrEP naïve – condomless sex was often stigmatised and PrEP use was seen as irresponsible. This limited PrEP discussions.
“But just from my background, it’s kind of a prudish background, but you never really talk openly about sex.” (22-year-old bisexual man, black British African, PrEP naïve).
Those who either wanted to access PrEP or had accessed it were able to have more straightforward conversations and also saw the importance of talking about the benefits of PrEP.