‘I make sure my doctor doesn’t know that I use meth’: perceived barriers to pre-exposure prophylaxis (PrEP) uptake among community peer educators in Seattle (WA, USA)
Vanessa M. McMahan A F , Lauren R. Violette A , Michele P. Andrasik B C , Aleks Martin D , Lindsay Garske D and Joanne D. Stekler A B E
+ Author Affiliations
- Author Affiliations
A Department of Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA.
B Department of Global Health, University of Washington, 1510 San Juan Road, Seattle, WA, 98195 USA.
C Fred Hutch, HIV Vaccine Trials Network, 1100 Fairview Avenue N, Seattle, WA, 98109, USA.
D Project NEON, Seattle Counseling Service, 1216 Pine Street, Suite 300, Seattle, WA, 98101, USA.
E Department of Epidemiology, University of Washington, 1959 NE Pacific Street Seattle, WA, 98195 USA.
F Corresponding author. Email: vmcmahan@uw.edu
Sexual Health 17(1) 29-37 https://doi.org/10.1071/SH19083
Submitted: 15 May 2019 Accepted: 18 September 2019 Published: 9 December 2019
Abstract
Background: HIV disproportionately affects cisgender men and transgender people who have sex with men (MSM/TG) and use methamphetamine. Pre-exposure prophylaxis (PrEP) uptake has been slow in this group. It is important to understand perceptions about PrEP and barriers to its use among MSM/TG who use methamphetamine to reduce new HIV infections. Methods: We conducted four focus groups with peer educators of a harm reduction program. We assessed their perspectives of PrEP and barriers across the PrEP continuum among MSM/TG who use methamphetamine. Results: Notably, stigma related to the multiple marginalised identities of MSM/TG who use methamphetamine (e.g. MSM/TG-related stigma, methamphetamine-related stigma) was a barrier at each step. We developed a framework that combined the PrEP continuum and a stigma-based treatment cascade to explore these themes and describe the effects of stigma on PrEP engagement. Methamphetamine-related barriers were also identified. Conclusions: The findings of this study emphasise the importance of incorporating stigma reduction into PrEP delivery for MSM/TG who use methamphetamine.
Additional keywords: HIV prevention, methamphetamine, peer educators, PrEP continuum.
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