Provider biases may be ‘undermining’ PrEP access
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A survey revealed systematic biases against people who inject drugs among primary and HIV care providers that may impact patients’ access to PrEP according to a study in AIDS and Behavior.
“There were several factors that motivated us to conduct this study, including documented social inequities in PrEP uptake, patient accounts of encountering stigmatizing reactions from providers when seeking PrEP, providers' expressed reservations about prescribing PrEP to certain groups, and early experimental studies suggesting biases in PrEP-related clinical decision-making among medical students,” Sarah K. Calabrese, PhD, assistant professor of clinical psychology at The George Washington University, told Healio.
Calabrese SK, et al. AIDS Behav. 2021;doi:10.1007/s10461-021-03495-3.
“Additionally, we believed the data from this study could help to inform future PrEP trainings for providers,” Calabrese said.
Calabrese and colleagues surveyed 370 primary and HIV care providers, asking them to review a fictitious medical record of a patient seeking PrEP, with records varying by patient race and risk behaviors, including men who have sex with men, men who have sex with women or men who inject drugs.
Overall, the study demonstrated that clinicians judged people who inject drugs as less responsible, less safety conscious and less likely to be adherent to PrEP.
“Providers judged the man who injected drugs more harshly than the patients with sexual risks, perceiving him as less responsible and less likely to adhere to PrEP, and these adverse judgments were indirectly linked to lower intention to prescribe for him,” Calabrese said.
Compared with other forms of social bias, bias against people who inject drugs may be a form of bias to which providers are less attuned, Calabrese said.
Additionally, the study demonstrated that there were limited biases based on sexual orientation and no evidence of biases based on race.
“As human beings, we are all vulnerable to social biases, and health care providers are no exception. It's important for health care organizations and individual providers to recognize this vulnerability and take steps to mitigate its potential impact on clinical care,” Calabrese said. “For example, implementing a standardized approach to PrEP delivery, whereby PrEP is routinely discussed with and — barring medical contraindications — made available to all adolescent and adult patients, would reduce the risk of provider biases undermining PrEP access.”
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