Knowledge, Attitudes, and Utilization of HIV PrEP among Black College Students in the United States: A Systematic Review
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Abstract:
Considering the diverse socio-cultural norms, sexual
attitudes, and mental and emotional immaturity that generally exist among young
adults, Black college students are behaviorally vulnerable to acquiring new HIV
infections before requisite exposure to HIV prevention education. Black college students (aged 18 to 34) fall
within the description of one of the highest priority populations at risk for
new HIV infection given the overall under-utilization and racial disparities in
the HIV pre-exposure prophylaxis (PrEP) coverage among Black
people in the United States (U.S). Yet,
research addressing
sexuality and HIV PrEP amongst Black college students are limited. This systematic review undertakes a
comprehensive exploratory search of eight databases and includes four studies
that have been conducted regarding Black college students HIV PrEP knowledge,
attitudes and PrEP utilization in the U.S. Our findings suggest a high rate of
sexual activity and hesitancy to initiate PrEP due
to fear, exacerbated by low comprehensive knowledge of PrEP, low self-perceived
HIV risk, and low HIV testing before any PrEP educational intervention.
Positive PrEP utilization was closely associated with high self-perceived HIV
risk following PrEP education, particularly when individual and structural
factors were satisfactorily addressed. Current evidence suggests that PrEP is
grossly under-utilized by Black college students who may benefit from it, and
attitudes are driven by multiple determinants informed by psycho-social and
structural barriers to PrEP access or acceptability in the U.S. Therefore, PrEP
education is a potent tool for improving sexual health behaviour and attitude
among Black college students.
References:
[1] Centers
for Disease Control and Prevention. National Black HIV/AIDS awareness day 2022.
2022 October 31, 2022]; Available from: https://www.cdc.gov/nchhstp/newsroom/2022/NBHAAD-2022.html.
[2] Okeke,
N.L., et al., Awareness and acceptability of HIV pre-exposure prophylaxis
(PrEP) among students at two historically Black universities (HBCU): a
cross-sectional survey, BioMed Central Public Health, 2021, 21(1): p. 943.
[3] Lindong,
I., et al., Similarities and differences matter: Considering the influence of
gender on HIV prevention programs for young adults in an urban HBCU, International
Journal of Environmental Research and Public Health, 2017, 14(2).
[4] Eaton,
L.A., et al., Minimal Awareness and Stalled Uptake of Pre-Exposure Prophylaxis
(PrEP) Among at Risk, HIV-Negative, Black Men Who Have Sex with Men, AIDS
Patient Care & STDs, 2015, 29(8):
p. 423-429.
[5] Allan-Blitz,
L.T., L.A. Mena, and K.H. Mayer, The ongoing HIV epidemic in American youth:
challenges and opportunities, Mhealth, 2021, 7: p. 33.
[6] Ssuna, B.,
et al., Factors associated with willingness to use oral pre-exposure
prophylaxis (PrEP) in a fisher-folk community in peri-urban Kampala, Uganda, BioMed
Central Public Health, 2022, 22(1).
[7] Centers
for Disease Control and Prevention. The HIV Surveillance Supplemental Report:
Monitoring selected national HIV prevention and care objectives by using HIV
surveillance data—United States and 6 dependent areas, 2019, 2021 January 29,
2023]; Available from: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-vol-26-no-2.pdf.
[8] Smith,
D.K., et al., Evidence of an Association of Increases in Pre-exposure
Prophylaxis Coverage with Decreases in Human Immunodeficiency Virus Diagnosis
Rates in the United States, 2012-2016, Clinical Infectious Diseases,
2020, 71(12): p. 3144-3151.
[9] Centers
for Disease Control and Prevention. HIV surveillance data table. 2023 July 27, 2023]; Available from: https://www.cdc.gov/hiv/library/reports/surveillance-data-tables/vol-4-no-2/index.html.
[10] Stutts,
L.A., et al., Lost in translation: College students’ knowledge of HIV and PrEP
in relation to their sexual health behaviors, Journal of American College
Health, 2022, 70(2): p. 561-567.
[11] Francis,
A.R., et al., Factor structure of the sexual risk survey among U.S. college
students with and without ADHD: Assessing clinical utility with a high-risk
population, Archives of Sexual Behavior, 2022, 51(6): p. 2931-2942.
[12] Jahanfar,
S. and Z. Pashaei, Sexual attitudes and associated factors of risky sexual
behaviors among university students, Brain and Behavior, 2022, 12(8).
[13] Centers
for Disease Control and Prevention. Estimated HIV Incidence and Prevalence: Key
Findings. 2023 July 12, 2023]; Available
from: https://www.cdc.gov/hiv/policies/dear-colleague/dcl/20230523.html.
[14] Centers
for Disease Control and Prevention. HIV Information and Youth. 2023 June 25,
2023]; Available from: https://www.cdc.gov/healthyyouth/youth_hiv/hiv-information-and-youth.htm.
[15] Ojikutu,
B.O., et al., HIV-Related Mistrust (or HIV Conspiracy Theories) and
Willingness to Use PrEP Among Black Women in the United States, AIDS and
Behavior, 2020, 24(10): p.
2927-2934.
[16] Ojikutu,
B., et al., All Black people are not alike: Differences in HIV testing
patterns, knowledge, and experience of stigma between U.S.-born and
non-U.S.-born Blacks in Massachusetts. AIDS Patient Care & STDs, 2013, 27(1): p. 45-54.
[17] Okeke,
N.L., et al., Awareness and acceptability of HIV pre-exposure prophylaxis
(PrEP) among students at two historically Black universities (HBCU): a
cross-sectional survey, BMC Public Health, 2021, 21(1): p. 943.
[18] Arnold, et
al., Preliminary investigation evaluating college students' willingness and
need to take pre-exposure prophylaxis (PrEP) for HIV, HIV and AIDS Review,
2018, 17(2): p. 98-102.
[19] Chandler,
R., et al., The pre-exposure prophylaxis (PrEP) consciousness of black college
women and the perceived hesitancy of public health institutions to curtail HIV
in black women, BMC Public Health, 2020, 20(1).
[20] Marshall,
S.A., et al., Current HIV testing & risk behaviors among students at
historically Black Colleges & Universities in a southern State, Journal
of the National Medical Association, 2020, 112(4): p. 374-380.
[21] Okeke,
N.L., et al., Awareness and acceptability of HIV pre-exposure prophylaxis
(PrEP) among students at two historically Black universities (HBCU): a
cross-sectional survey, BMC Public Health, 2021, 21(1).
[22] Marshall,
S.A., et al., Current HIV Testing & Risk Behaviors among Students at
Historically Black Colleges & Universities in a Southern State, Journal
of the National Medical Association, 2020, 112(4): p. 374-380.
[23] Chandler,
R., et al., The pre-exposure prophylaxis (PrEP) consciousness of black college
women and the perceived hesitancy of public health institutions to curtail HIV
in black women, BMC Public Health, 2020, 20(1): p. 1172.
[24] Mangum,
J.B. Craddock, and D.L. Whitfield, Associations in preventive sexual health
service utilization and pre-exposure prophylaxis (PrEP) interest among young
Black women in the United States, 2018, AIDS Care, 2022, 34(3): p. 324-330.
[25] Hirschhorn,
L.R., et al., Black cisgender women's PrEP knowledge, attitudes, preferences,
and experience in Chicago, JAIDS: Journal of Acquired Immune Deficiency
Syndromes, 2020. 84(5): p.
497-507.
[26] Bond,
K.T., et al., Using an Intersectional Framework to Understand the Challenges of
Adopting Pre-exposure Prophylaxis (PrEP) Among Young Adult Black Women, Sex
Res Social Policy, 2022, 19(1):
p. 180-193.
[27] Nieto, O.,
et al., Barriers and motivators to pre-exposure prophylaxis uptake among Black
and Latina transgender women in Los Angeles: perspectives of current PrEP users,
AIDS Care, 2021, 33(2): p.
244-252.
[28] Shorrock,
F., et al., Dismantling Barriers and Transforming the Future of Pre-Exposure
Prophylaxis Uptake in Young Black and Latinx Sexual Minority Men and
Transgender Women, AIDS Patient Care & STDs, 2022, 36(5): p. 194-203.
[29] Craddock,
J.B., N.D. Franke, and C. Kingori, Associations of Social Network- and
Individual-Level Factors with HIV Testing, Condom Use, and Interest in PrEP
Among Young Black Women, Archives of Sexual Behavior, 2022, 51(5): p. 2473-2483.
[30] Gailloud,
L., et al., 'How come they don't talk about it in school?' Identifying
adolescent barriers to PrEP use, Health Educ Res, 2022, 36(5): p. 505-517.
[31] Centers
for Disease Control and Prevention. Pre-Exposure Prophylaxis for the prevention
of HIV infection in the United States - 2021 update: A clinical practice
guideline. 2021 February 25, 2023];
Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf.
[32] Macapagal,
K. This HIV prevention medicine is for everyone. Why do so few people take it?
2022 February 24, 2023]; Available from:
https://www.statnews.com/2022/01/20/this-hiv-prevention-medicine-is-for-everyone-why-do-so-few-people-take-it/.
[33] Qiao, S.,
Zhou, G, Li, X,, Disclosure of same-sex behaviors to health-care providers and
uptake of HIV testing for men who have sex with me: A systematic review, American
Journal of Mens Health, 2018, 12(5):
p. 1197 - 1214.
[34] Petroll,
A., E, Mosack, K, E, 2021, Physician awareness of sexual orientation and
preventive health recommendations to men who have sex with men, Journal of
Sexuallly Transmitted Diseases, 38(1):
p. 63.
[35] Rao, et
al., "You Don't Want Your Parents Knowing That You're Taking Pre-exposure
Prophylaxis": Pre-exposure Prophylaxis Stigma Among Black and Latinx
Adolescents, J Assoc Nurses AIDS Care, 2022, 33(4): p. 395-405.
[36] Campbell,
J.T., et al., PrEP Familiarity, Interest, and Usage Among 364 Black and
Hispanic Adults in Indiana, Front Public Health, 2022, 10: p. 810042.
[37] Jones,
J.T., et al., Community Members' Pre-exposure Prophylaxis Awareness, Attitudes,
and Trusted Sources for PrEP Information and Provision, Context Matters Survey,
2015–2016, AIDS Education & Prevention, 2020, 32(2): p. 102-102.
[38] Chan,
S.S., et al., Pre-exposure prophylaxis for preventing acquisition of HIV: A
cross-sectional study of patients, prescribers, uptake, and spending in the
United States, 2015-2016, PLoS Medicine, 2020. 17(4): p. 1-17.
[39] Craddock,
J.B., et al., The Associations of HIV Pre-Exposure Prophylaxis Interest and
Sexual Risk Behaviors Among Young Black Women, AIDS Patient Care & STDs,
2021, 35(7): p. 263-270.
[40] Ojikutu,
B.O., et al., African born women living with HIV in the United States: unmet
needs and opportunities for intervention, AIDS Care, 2018, 30(12): p. 1542-1550.
[41] Tamir, C.
Key findings about Black America. 2021
November 1, 2022]; Available from: https://www.pewresearch.org/fact-tank/2021/03/25/key-findings-about-black-america/.
[42] Arrington-Sanders,
R., et al., Role of Structural Marginalization, HIV Stigma, and Mistrust on HIV
Prevention and Treatment Among Young Black Latinx Men Who Have Sex with Men and
Transgender Women: Perspectives from Youth Service Providers, AIDS Patient
Care STDS, 2020, 34(1): p. 7-15.
[43] Chandler,
R., Sexual and Reproductive Health Knowledge Gaps Identified by Black Women:
Considerations for the Nurse Educator, ABNF Journal, 2020, 31(3): p. 88-94.
[44] Marshall,
S.A., et al., Current HIV Testing & Risk Behaviors among Students at
Historically Black Colleges & Universities in a Southern State, J Natl
Med Assoc, 2020, 112(4): p.
374-380.
[45] Chandler, R., et al., (2020) The pre-exposure
prophylaxis (PrEP) consciousness of Black college women and the perceived
hesitancy of public health institutions to curtail HIV in Black women, BioMed
Central Public Health, 20(1).
