Systematic Bias May Affect Access to PrEP in United States

US provider bias toward people who inject drugs could pose a barrier to preexposure prophylaxis (PrEP) to prevent human immunodeficiency virus (HIV) infection, according to study results published online ahead of print in AIDS and Behavior.

“Health care providers can play a pivotal role in raising awareness about PrEP and enabling access to this important preventive resource, but they are not routinely offering it to patients, particularly patients who inject drugs,” said study lead author Sarah Calabrese, PhD, an assistant professor of clinical psychology at George Washington University. “We wanted to find out whether there were systematic biases against people who inject drugs in providers’ clinical judgments related to PrEP.”

The study included 370 primary and HIV care providers from the United States. Each reviewed a fictitious medical record of a patient seeking PrEP. Records differed in terms of patient race, sexual orientation, and injection drug use.

Providers expressed less favorable judgements toward patients who injected drugs, according to the study. Such patients were considered less responsible, less safety-conscious, and less likely to be adherent to PrEP compared with other patients, according to the study. There was limited evidence of provider bias based on sexual orientation and no evidence of bias based on race.

Adverse adherence and responsibility judgements by providers were linked with lower intentions to prescribe PrEP, the study showed.

Researchers recognized that providers may be unaware of their vulnerability to such bias and, consequently, may benefit from education in bias reduction and cultural competence. They also pointed out that limiting access to PrEP can also limit access to other essential health resources, including medication-based treatment for addiction and access to naloxone in the event of opioid overdose.

“Upon learning of it, many people who inject drugs have expressed positive attitudes toward PrEP. However, only about 25% of people who inject drugs in the United States are aware of PrEP, and less than 1% have recently used PrEP,” Dr Calabrese said. “Our study shows the importance of raising awareness about PrEP as a preventive resource for both sexual and injection-related risks, and standardizing access to it for all people through policies and guidelines.”

References:

1. Calabrese SK, Kalwicz DA, Modrakovic D, et al. An experimental study of the effects of patient race, sexual orientation, and injection drug use on providers' PrEP-related clinical judgments [published online ahead of print Nov 9, 2021]. AIDS and Behav. doi:10.1007/s10461-021-03495-3
2. New study suggests healthcare provider biases can impact a patient’s access to preventative HIV drug. News release. George Washington University. November 8, 2021. Accessed November 18, 2021.