An Experimental Study of the Effects of Patient Race, Sexual Orientation, and Injection Drug Use on Providers' PrEP-Related Clinical Judgments

Sarah K Calabrese; David A Kalwicz; Djordje Modrakovic; Valerie A Earnshaw; E Jennifer Edelman; Samuel R Bunting; Ana María Del Río-González; Manya Magnus; Kenneth H Mayer; Nathan B Hansen; Trace S Kershaw; Joshua G Rosenberger; Douglas S Krakower; John F Dovidio

doi:10.1007/s10461-021-03495-3

An Experimental Study of the Effects of Patient Race, Sexual Orientation, and Injection Drug Use on Providers' PrEP-Related Clinical Judgments

AIDS Behav. 2022 May;26(5):1393-1421. doi: 10.1007/s10461-021-03495-3. Epub 2021 Nov 9.

Authors

Sarah K Calabrese^{1

2}, David A Kalwicz³, Djordje Modrakovic³, Valerie A Earnshaw⁴, E Jennifer Edelman⁵, Samuel R Bunting⁶, Ana María Del Río-González³, Manya Magnus⁷, Kenneth H Mayer^{8

9}, Nathan B Hansen¹⁰, Trace S Kershaw¹¹, Joshua G Rosenberger¹², Douglas S Krakower^{8

9}, John F Dovidio^{11

13}

Affiliations

¹ Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA. skcalabrese@gwu.edu.
² Department of Prevention and Community Health, George Washington University, Washington, DC, USA. skcalabrese@gwu.edu.
³ Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
⁴ Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA.
⁵ Department of General Internal Medicine, Yale University, New Haven, CT, USA.
⁶ Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
⁷ Department of Epidemiology, George Washington University, Washington, DC, USA.
⁸ The Fenway Institute, Fenway Health, Boston, MA, USA.
⁹ Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA.
¹⁰ Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA.
¹¹ Department of Social and Behavioral Sciences, Yale University, New Haven, CT, USA.
¹² Department of Biobehavioral Health, Penn State University, University Park, PA, USA.
¹³ Department of Psychology, Yale University, New Haven, CT, USA.

Abstract
in English, Spanish

Social biases may influence providers' judgments related to pre-exposure prophylaxis (PrEP) and patients' consequent PrEP access. US primary and HIV care providers (n = 370) completed an experimental survey. Each provider reviewed one fictitious medical record of a patient seeking PrEP. Records varied by patient race (Black or White) and risk behavior (man who has sex with men [MSM], has sex with women [MSW], or injects drugs [MID]). Providers reported clinical judgments and completed measures of prejudice. Minimal evidence of racially biased judgments emerged. Providers expressing low-to-moderate sexual prejudice judged the MSM as more likely than the MSW to adhere to PrEP, which was associated with greater PrEP prescribing intention; sexual prejudice was negatively associated with anticipated MSM adherence. Providers judged the MID to be at higher risk, less likely to adhere, less safety-conscious, and less responsible than both the MSM and MSW; adverse adherence and responsibility judgments were associated with lower prescribing intention.

Los sesgos sociales pueden influir sobre los juicios de proveedores de salud con respecto a la profilaxis pre-exposición (PrEP) y el consecuente acceso de los pacientes a PrEP. Proveedores de cuidados primarios y de VIH en los Estados Unidos (n = 370) respondieron una encuesta experimental. Cada proveedor leyó una historia médica de un paciente ficticio interesado en obtener PrEP. Las historias médicas variaron la raza (Negro o Blanco) y conducta de riesgo (hombre que tiene sexo con hombres [HSH], hombre que tiene sexo con mujeres [HSM], u hombre usuario de drogas inyectables [HDI]) del paciente. Los proveedores reportaron juicios clínicos y completaron medidas sobre prejuicio. La evidencia sobre sesgos raciales en los juicios clínicos fue mínima. Los proveedores que expresaron prejuicio sexual bajo a moderado, juzgaron que el paciente HSH tendría mayor adherencia a PrEP que el paciente HSM, lo cual se asoció con mayor intención de prescribir PrEP; el prejuicio sexual se asoció negativamente con la adherencia anticipada en HSH. El paciente HDI fue percibido como en mayor riesgo, con menor adherencia, menos preocupado por la seguridad, y menos responsable que los HSH y HSM; los juicios sobre baja adherencia y responsabilidad estuvieron asociados con menor intención de prescribir PrEP.

Keywords: Clinical decision-making; HIV; Health personnel; Pre-exposure prophylaxis; Prejudice.

MeSH terms

Anti-HIV Agents* / therapeutic use
Female
HIV Infections* / drug therapy
HIV Infections* / prevention & control
Homosexuality, Male
Humans
Judgment
Male
Pre-Exposure Prophylaxis*
Sexual Behavior
Sexual and Gender Minorities*

Substances

Anti-HIV Agents

Abstract in English, Spanish

MeSH terms

Substances

Grants and funding

Abstract
in English, Spanish