Recommendations to Increase PrEP Uptake and Adherence: A Review of the Barriers and Challenges to PrEP Uptake and Adherence Among Black Women in The Southeastern United States Open Access

Enyinnia, Ndidi (Spring 2018)

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Background: Black women are disproportionately affected by HIV within the United States, especially within the Southeastern region. Despite the introduction of PrEP as an effective prevention method, HIV rates among Black women remain high. A review of the literature was undertaken to examine the barriers and challenges to PrEP uptake and adherence, in addition to techniques addressing the barriers.


Objectives: The purpose of this review is to summarize the literature on PrEP uptake and adherence among Black women in the Southeastern region of the United States. Additionally, this review seeks to increase the understanding of the barriers and challenges that may inhibit PrEP uptake and adherence. This review also analyzes and presents effective HIV prevention techniques and recommendations that address the challenges and barriers to PrEP adherence.


Methods: A review of the literature was conducted in Medline as well as Google Scholar for peer-reviewed articles from 2008-2018 addressing PrEP use among Black women.


Results: The search for articles in Medline and Google Scholar yielded 11 articles. The results of these articles revealed that Black women face a multitude of behavioral, social, and structural barriers toward PrEP uptake and adherence. The main findings showed the cost of PrEP, stigma associated with PrEP, and inconsistent use were major barriers to PrEP uptake and adherence. Based on the findings, techniques were recommended to address the challenges to uptake and adherence.


Conclusions: Understanding the behavioral, social, and structural barriers Black women face, especially within the Southeast, is essential to PrEP research and prevention initiatives. Using techniques that address the multiple barriers is key to reducing the HIV incidence and prevalence among Black women. Addressing the unequal power dynamics between Black men and women is essential to increasing PrEP uptake.  Additionally, implementing community-wide education and incorporating culturally competent care are practical techniques to addressing the barriers.

Table of Contents

Introduction & Rationale. 1

Problem Statement 1

Purpose Statement 2

Significance Statement: 3

Definition of Terms. 3

Chapter II: Methods. 5

Literature Search Methodology. 5

Data Extraction and Management 6

Quality Assessment 7

Analysis Plan. 7

Chapter III: Literature Review on PrEP as Prevention. 9

PrEP as Prevention. 9

Chapter IV: Literature Review on Barriers. 12

Behavioral Barriers. 12

Social Barriers. 14

Structural Barriers. 16

Specific Population Barriers. 18

Review of Literature Summary and Study Relevance. 20

Chapter V: Effective Approaches. 21

Addressing Behavioral Barrier 21

Addressing Social Barriers. 22

Addressing Structural Barriers. 23

Addressing Transgender-Specific Barriers. 24

Chapter VI: Results. 26

PrEP as Prevention. 26

Behavioral Barriers. 26

Social Barriers. 27

Structural Barriers. 28

Special Population Barriers. 28

Chapter VII: Discussion, Recommendations, and Conclusion. 30

Introduction & Summary. 30

Discussion and Recommendations. 30

Implications and Recommendations. 32

Strengths & Weaknesses. 33

Conclusion. 34

Figures & Tables. 36

Appendix. 39

References. 44


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