Skip to main content

Advertisement

SpringerLink
Log in

Pre-Exposure Prophylaxis (PrEP) Dissemination: Adapting Diffusion Theory to Examine PrEP Adoption

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

PrEP adoption among African-American men-who-have-sex-with-men (AAMSM) remains low. We applied Diffusion-of-Innovations (DOI) theory to understand PrEP adoption processes among young HIV-negative/status unknown AAMSM (AAYMSM; N = 181; 17–24 years). Quantitative and qualitative analyses were used to examine predictors of PrEP diffusion stages. Most AAYMSM were in the persuasion stage (PrEP-aware, hadn’t adopted; 72.4%). Our results suggest that model antecedents are DOI stage-specific. PrEP awareness (knowledge stage) was associated with lower levels of social stigma (p < .03) and greater health literacy (p < .05), while sexual risk (p < .03) and education (p < .03) predicted PrEP adoption (12.2%). PrEP efficacy and side effects were primary innovation characteristics influencing adoption receptivity in the persuasion stage. Interventions to improve PrEP diffusion should be tailored to stage-specific antecedents depending on how a community is stratified across the DOI stages.

Resumen

La adopción de Pre-exposición Profilaxis (PrEP) entre hombres afroamericanos que tienen relaciones sexuales con otros hombres (HASH) sige baja. Aplicamos la teoría de la difusión de innovaciones para comprender los procesos de adopción de la PrEP entre los hombres jóvenes afroamericanos que tienen relaciones sexuales con otros hombres (HJASH) VIH negativos/estado desconocido (HJASH; N = 181; 17–24 años). Se utilizaron análisis cuantitativos y cualitativos para examinar los predictores de las etapas de difusión de PrEP. La mayoría de los HJASH se encontraban en la etapa de persuasión (conscientes de la PrEP, no la habían adoptado; 72.4%). Nuestros resultados sugieren que los antecedentes del modelo son específicos de la etapas de la difusión de innovaciones. La conciencia de la PrEP (etapa de conocimiento) se asoció con niveles más bajos de estigma social (p <.03) y una mayor alfabetización en salud (p <.05), mientras que el riesgo sexual (p <.03) y la educación (p < .03) predijeron la adopción de la PrEP (12.2%). La eficacia y los efectos secundarios de la PrEP fueron las principales características de la innovación que influyeron en la receptividad de la adopción en la etapa de persuasión. Las intervenciones para mejorar la difusión de la PrEP deben adaptarse a los antecedentes específicos de la etapa, dependiendo de cómo se estratifique una comunidad en las etapas del la difusión de innovaciones.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention, US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States—2017 Update: a clinical practice guideline. [Internet]. Washington, D.C.; 2018 Mar. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf

  2. Smith DK, Handel MV, Grey J. Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group, and race/ethnicity, United States, 2015. Ann Epidemiol. 2018;28(12):850-857.e9.

    Article  PubMed  Google Scholar 

  3. Eaton LA, Driffin DD, Bauermeister J, Smith H, Conway-Washington C. 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):423–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Khanna AS, Schumm P, Schneider JA. Facebook network structure and awareness of preexposure prophylaxis among young men who have sex with men. Ann Epidemiol. 2017;27(3):176–80.

    Article  PubMed  Google Scholar 

  5. Misra K, Huang JS, Udeagu C-CN. Ongoing disparities in prediagnosis preexposure prophylaxis use among persons recently diagnosed with HIV in New York city, 2015–2017. Am J Public Health. 2019;109(9):1212–5.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Centers for Disease Control and Prevention. CDC HIV Prevention Progress Report, 2019. Washington, D.C.; 2019 Mar p. https://www.cdc.gov/hiv/pdf/policies/progressreports/cdc-hiv-preventionprogressreport.pdf.

  7. Centers for Disease Control and Prevention (CDC). HIV Surveillance Report, 2017 [Internet]. Washington, D.C.; 2018 Nov. Report No.: Vol. 29. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html

  8. Scott HM, Spinelli M, Vittinghoff E, Morehead-Gee A, Hirozawa A, James C, et al. Racial/ethnic and HIV risk category disparities in preexposure prophylaxis discontinuation among patients in publicly funded primary care clinics. AIDS. 2019;33(14):2189–95.

    Article  PubMed  Google Scholar 

  9. Khanna A, Michaels S, Skaathun B, et al. Preexposure prophylaxis awareness and use in a population-based sample of young black men who have sex with men. JAMA Intern Med. 2016;176(1):136–8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Rolle C-P, Rosenberg ES, Siegler AJ, Sanchez TH, Luisi N, Weiss K, et al. Challenges in translating PrEP interest into uptake in an observational study of young black MSM. JAIDS J Acquir Immune Defic Syndr [Internet]. 2017;76(3):250.

    Article  PubMed  Google Scholar 

  11. Rogers EM. Diffusion of Innovations. 5th ed. New York: Free Press; 2003.

    Google Scholar 

  12. Dearing JW. Evolution of diffusion and dissemination theory. J Public Health Manag Pract. 2008;14(2):99–108.

    Article  PubMed  Google Scholar 

  13. Dearing JW, Kreuter MW. Designing for diffusion: How can we increase uptake of cancer communication innovations? Extending Reach Eff Effic Commun Evid Cent Excell Cancer Commun Res. 2010;1(81):S100–10.

    Google Scholar 

  14. Dearing JW, Maibach EW, Buller DB. A convergent diffusion and social marketing approach for disseminating proven approaches to physical activity promotion. Diffus Dissem Phys Act Recomm Programs World Popul. 2006;31(4):11–23.

    Google Scholar 

  15. Kreuter MW, Bernhardt JM. Reframing the dissemination challenge: a marketing and distribution perspective. Am J Public Health. 2009;99(12):2123–7.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Oldenburg B, Glanz K. Diffusion of innovations. In: Tracy Orleans C, editor. Health behavior and health education—theory, research, and practice. San Francisco, CA: Jossey-Boss; 2008. p. 313–30.

    Google Scholar 

  17. World Health Organization. What’s the 2+1+1? Event-driven oral pre-exposure prophylaxis to prevent HIV for men who have sex with men: Update to WHO’s recommendation on oral PrEP [Internet]. Geneva; 2019. https://www.who.int/hiv/pub/prep/211/en/

  18. Molina J-M, Charreau I, Spire B, Cotte L, Chas J, Capitant C, et al. Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study. Lancet HIV. 2017;4(9):e402–10.

    Article  PubMed  Google Scholar 

  19. Halkitis PN, Jaiswal J, Griffin-Tomas M, Krause KD, D’Avanzo P, Kapadia F. Beliefs about the end of AIDS, concerns about PrEP functionality, and perceptions of HIV risk as drivers of PrEP use in urban sexual minority men: The P18 cohort study. AIDS Behav. 2018;22(11):3705–17.

    Article  PubMed  Google Scholar 

  20. Raifman JRG, Flynn C, German D. Healthcare provider contact and pre-exposure prophylaxis in baltimore men who have sex with men. Am J Prev Med. 2017;52(1):55–63.

    Article  PubMed  Google Scholar 

  21. Holt M, Lee E, Lea T, Bavinton B, Broady T, Mao L, et al. HIV preexposure prophylaxis cascades to assess implementation in Australia: results from repeated, national behavioral surveillance of gay and bisexual men, 2014–2018. JAIDS J Acquir Immune Defic Syndr. 2020;83(3):e16.

    Article  PubMed  Google Scholar 

  22. Garnett M, Hirsch-Moverman Y, Franks J, Hayes-Larson E, El-Sadr WM, Mannheimer S. Limited awareness of pre-exposure prophylaxis among black men who have sex with men and transgender women in New York city. AIDS Care. 2018;30(1):9–17.

    Article  PubMed  Google Scholar 

  23. Rolle C-P, Rosenberg ES, Luisi N, Grey J, Sanchez T, del Rio C, et al. Willingness to use pre-exposure prophylaxis among Black and White men who have sex with men in Atlanta. Georgia Int J STD AIDS. 2016;28(9):849–57.

    Article  PubMed  Google Scholar 

  24. Gamarel KE, Golub SA. Intimacy motivations and pre-exposure prophylaxis (PrEP) adoption intentions among HIV-negative men who have sex with men (MSM) in romantic relationships. Ann Behav Med. 2014;49(2):177–86.

    Article  Google Scholar 

  25. Kuhns LM, Hotton AL, Schneider J, Garofalo R, Fujimoto K. Use of pre-exposure prophylaxis (PrEP) in young men who have sex with men is associated with race, sexual risk behavior and peer network size. AIDS Behav. 2017;21(5):1376–82.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Holloway IW, Dougherty R, Gildner J, Beougher SC, Pulsipher C, Montoya JA, et al. Brief report: PrEP uptake, adherence, and discontinuation among Aalifornia YMSM using geosocial networking applications. J Acquir Immune Defic Syndr. 2017;74(1):15–20.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Newcomb ME, Moran K, Feinstein BA, Forscher E, Mustanski B. Pre-exposure prophylaxis (PrEP) use and condomless anal sex: evidence of risk compensation in a cohort of young men who have sex with men. J Acquir Immune Defic Syndr 1999. 2018;77(4):358–64.

    Article  Google Scholar 

  28. Goedel WC, Halkitis PN, Greene RE, Duncan DT. Correlates of awareness of and willingness to use pre-exposure prophylaxis (PrEP) in gay, bisexual, and other men who have sex with men who use geosocial-networking smartphone applications in New York city. AIDS Behav. 2016;20(7):1435–42.

    Article  PubMed  Google Scholar 

  29. Strauss BB, Greene GJ, Phillips G, Bhatia R, Madkins K, Parsons JT, et al. Exploring patterns of awareness and use of HIV pre-exposure prophylaxis among young men who have sex with men. AIDS Behav. 2017;21(5):1288–98.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Maksut JL, Eaton LA, Driver R, Knowles CM, Watson RJ. Factors associated with awareness and use of pre-exposure prophylaxis (PrEP) among Black men who have sex with men with a recent STI diagnosis. Behav Med. 2020;47(2):161–9.

    Article  PubMed  Google Scholar 

  31. Sang JM, Matthews DD, Meanley SP, Eaton LA, Stall RD. Assessing HIV stigma on prevention strategies for black men who have sex with men in the United States. AIDS Behav. 2018;22(12):3879–86.

    Article  PubMed  Google Scholar 

  32. Phillips G, Neray B, Birkett M, Felt D, Janulis P, Mustanski B. Role of social and sexual network factors in PrEP utilization among YMSM and transgender women in Chicago. Prev Sci. 2019;20(7):1089–97.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Shover CL, Javanbakht M, Shoptaw S, Bolan RK, Lee S-J, Parsons JT, et al. HIV preexposure prophylaxis initiation at a large community clinic: differences between eligibility, awareness, and uptake. Am J Public Health. 2018;108(10):1408–17.

    Article  PubMed  PubMed Central  Google Scholar 

  34. John SA, Rendina HJ, Grov C, Parsons JT. Home-based pre-exposure prophylaxis (PrEP) services for gay and bisexual men: An opportunity to address barriers to PrEP uptake and persistence. PLoS ONE. 2017;12(12):e0189794.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  35. Turan B, Hatcher AM, Weiser SD, Johnson MO, Rice WS, Turan JM. Framing mechanisms linking HIV-related stigma, adherence to treatment, and health outcomes. Am J Public Health. 2017;107(6):863–9.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Philbin MM, Parker CM, Parker RG, Wilson PA, Garcia J, Hirsch JS. The promise of pre-exposure prophylaxis for black men who have sex with men: an ecological approach to attitudes, beliefs, and barriers. AIDS Patient Care STDs. 2016;30(6):282–90.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Oldenburg CE, Perez-Brumer AG, Hatzenbuehler ML, Krakower D, Novak DS, Mimiaga MJ, et al. State-level structural sexual stigma and HIV prevention in a national online sample of HIV-uninfected MSM in the United States. AIDS Lond Engl. 2015;29(7):837–45.

    Article  Google Scholar 

  38. Sun CJ, Anderson KM, Toevs K, Morrison D, Wells C, Nicolaidis C. “Little Tablets of Gold”: an examination of the psychological and social dimensions of PrEP among LGBTQ communities. AIDS Educ Prev. 2019;31(1):51–62.

    Article  PubMed  Google Scholar 

  39. Catania JA, Dolcini MM, Harper G, Fortenberry D, Singh RR, Jamil O, et al. OHIV self-implemented testing: performance fidelity among African American MSM. AIDS Behav. 2019. https://doi.org/10.1007/s10461-019-02711-5.

    Article  Google Scholar 

  40. Fortenberry JD, McFarlane M, Bleakley A, Bull S, Fishbein M, Grimley DM, et al. Relationships of stigma and shame to gonorrhea and HIV screening. Am J Public Health. 2002;92(3):378–81.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Yebei VN, Fortenberry JB, Ayuku DO. Felt stigma among people living with HIV/AIDS in rural and urban Kenya. Afr Health Sci. 2008;8(2):97–102.

    PubMed  PubMed Central  Google Scholar 

  42. Saldaña J. The coding manual for qualitative researchers. London: Sage; 2015.

    Google Scholar 

  43. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.

    Article  PubMed  Google Scholar 

  44. Holt M. HIV pre-exposure prophylaxis and treatment as prevention: a review of awareness and acceptability among men who have sex with men in the Asia-Pacific region and the Americas. Sex Health. 2013;11(2):166–70.

    Article  Google Scholar 

  45. Peng P, Su S, Fairley CK, Chu M, Jiang S, Zhuang X, et al. A global estimate of the acceptability of pre-exposure prophylaxis for HIV among men who have sex with men: a systematic review and meta-analysis. AIDS Behav. 2018;22(4):1063–74.

    Article  PubMed  Google Scholar 

  46. Young LE, Schumm P, Alon L, Bouris A, Ferreira M, Hill B, et al. PrEP Chicago: a randomized controlled peer change agent intervention to promote the adoption of pre-exposure prophylaxis for HIV prevention among young Black men who have sex with men. Clin Trials. 2018;15(1):44–52.

    Article  PubMed  Google Scholar 

  47. Dehlin JM, Stillwagon R, Pickett J, Keene L, Schneider JA. #PrEP4Love: an evaluation of a sex-positive HIV prevention campaign. JMIR Public Health Surveill. 2019;5(2):e12822.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Mahajan AP, Sayles JN, Patel VA, Remien RH, Sawires SR, Ortiz DJ, et al. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS Lond Engl. 2008;22(2):S67–79.

    Article  Google Scholar 

  49. Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36(1):38–56.

    Article  CAS  PubMed  Google Scholar 

  50. Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol. 2001;27(1):363–85.

    Article  Google Scholar 

  51. Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Warren JC, Fernández MI, Harper GW, Hidalgo MA, Jamil OB, Torres RS. Predictors of unprotected sex among young sexually active African American, hispanic, and white MSM: the importance of ethnicity and culture. AIDS Behav. 2008;12(3):459–68.

    Article  PubMed  Google Scholar 

  53. Harper GW, Wilson BDM. Situating sexual orientation and gender identity diversity in context and communities. In: Bond MA, editor. Handbook of community psychology: theoretical foundations, core concepts, and emerging challenges, vol. 1. American Psychological Association. DC: Washington; 2017. p. 387–402.

    Google Scholar 

  54. Graham R, Berkowitz B, Blum R, Bockting W, Bradford J, de Vries B, et al. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington, DC: The National Academies Press; 2011. p. 89–139.

    Google Scholar 

  55. Barker DH, Swenson RR, Brown LK, Stanton BF, Vanable PA, Carey MP, et al. Blocking the benefit of group-based HIV-prevention efforts during adolescence: the problem of HIV-related stigma. AIDS Behav. 2012;16(3):571–7.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Bond KT, Gunn A, Williams P, Leonard NR. Using an intersectional framework to understand the challenges of adopting pre-exposure prophylaxis (PrEP) among young adult black women. Sex Res Soc Policy. 2021. https://doi.org/10.1007/s13178-021-00533-6.

    Article  Google Scholar 

  57. Waite KR, Paasche-Orlow M, Rintamaki LS, Davis TC, Wolf MS. Literacy, social stigma, and HIV medication adherence. J Gen Intern Med. 2008;23(9):1367.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Whitfield TH, John SA, Rendina HJ, Grov C, Parsons JT. Why I quit pre-exposure prophylaxis (PrEP)? A mixed-method study exploring reasons for PrEP discontinuation and potential re-initiation among gay and bisexual men. AIDS Behav. 2018;22(11):3566–75.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Gilead Sciences, Inc. How can you get help paying fo Truvada for PrEP? [Internet]. 2019 [cited 2019 Oct 20]. https://www.truvada.com/how-to-get-truvada-for-prep/truvada-cost

  60. Whitfield TH, Parsons JT, Rendina HJ. Rates of pre-exposure prophylaxis use and discontinuation among a large US national sample of sexual minority men and adolescents. Arch Sex Behav. 2020;49(1):103–12.

    Article  PubMed  Google Scholar 

  61. Grace D, Jollimore J, MacPherson P, Strang MJ, Tan DH. The pre-exposure prophylaxis-stigma paradox: learning from Canada’s first wave of PrEP users. AIDS Patient Care STDs. 2018;32(1):24–30.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Golub SA. PrEP stigma: implicit and explicit drivers of disparity. Curr HIV/AIDS Rep. 2018;15(2):190–7.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Myers JE, Edelstein ZR, Daskalakis DC, Gandhi AD, Misra K, Rivera AV, et al. Preexposure prophylaxis monitoring in New York City: a public health approach. Am J Public Health. 2018;108(S4):S251–7.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Holt M, Lea T, Bear B, Halliday D, Ellard J, Murphy D, et al. Trends in attitudes to and the use of HIV pre-exposure prophylaxis by australian gay and bisexual men, 2011–2017: implications for further implementation from a diffusion of innovations perspective. AIDS Behav. 2019;23(7):1939–50.

    Article  PubMed  Google Scholar 

  65. Schneider JA, Young L, Ramachandran A, Michaels S, Cohen H, Robinson I, et al. A pragmatic randomized controlled trial to increase prep uptake for HIV prevention: 55-week results from PrEPChicago. J Acquir Immune Defic Syndr 1999. 2021;86(1):31–7.

    Article  Google Scholar 

  66. Grov C, Rendina HJ, Parsons JT. Birth cohort differences in sexual identity development milestones among HIV-negative gay and bisexual men in the United States. J Sex Res. 2018;55(8):984–94.

    Article  PubMed  Google Scholar 

  67. Watson RJ, Fish JN, Allen A, Eaton L. Sexual identity disclosure and awareness of HIV prevention methods among black men who have sex with men. J Sex Res. 2018;55(8):975–83.

    Article  PubMed  Google Scholar 

  68. Powell W, Richmond J, Mohottige D, Yen I, Joslyn A, Corbie-Smith G. Medical mistrust, racism, and delays in preventive health screening among African-American men. Behav Med. 2019;45(2):102–17.

    Article  PubMed  Google Scholar 

  69. Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson D, Mayer KH. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston. Massachusetts AIDS Care. 2017;29(11):1351–8.

    Article  PubMed  Google Scholar 

  70. Quinn K, Dickson-Gomez J, Zarwell M, Pearson B, Lewis M. “A Gay man and a doctor are just like, a recipe for destruction”: how racism and homonegativity in healthcare settings influence PrEP uptake among young black MSM. AIDS Behav. 2019;23(7):1951–63.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Kanny D, Jeffries WL 4th, Chapin-Bardales J, Denning P, Cha S, Finlayson T, et al. Racial/ethnic disparities in HIV preexposure prophylaxis among men who have sex with men—23 urban areas, 2017. MMWR Morb Mortal Wkly Rep. 2019;68(37):801–6.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Harris NS, Johnson AS, Huang Y-LA, Kern D, Fulton P, Smith DK, et al. Vital signs: status of human immunodeficiency virus testing, viral suppression, and HIV preexposure prophylaxis—United States, 2013–2018. MMWR Morb Mortal Wkly Rep. 2019;68(48):1117–23.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Nunn AS, Brinkley-Rubinstein L, Oldenburg CE, Mayer KH, Mimiaga M, Patel R, et al. Defining the HIV pre-exposure prophylaxis care continuum. AIDS Lond Engl. 2017;31(5):731–4.

    Article  Google Scholar 

  74. Zhang C, McMahon J, Fiscella K, Przybyla S, Braksmajer A, LeBlanc N, et al. HIV pre-exposure prophylaxis implementation cascade among health care professionals in the United States: implications from a systematic review and meta-analysis. AIDS Patient Care STDs. 2019;33(12):507–27.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This study was funded by National Institutes of Health grant MH105180 (PI: Catania); manuscript preparation also funded by Provost’s Distinguished Graduate Fellowship from Oregon State University Graduate School for Ms. Schuyler. The authors would like to acknowledge the contributions of Ryan Singh, Amy Young, Kodasha Thomas, Tori Geter on data preparation, and Gisele Corletto on abstract translation, as well as the time and efforts of study interviewers and participants. We’d like to thank OraSure Corporation for developing desensitized Oral HIV self-test kits for the current study.

Funding

This study was funded by National Institutes of Health grant MH105180 (PI: Catania); manuscript preparation also funded by Provost’s Distinguished Graduate Fellowship from Oregon State University Graduate School for Ms. Schuyler.

Author information

Authors and Affiliations

  1. School of Social and Behavioral Health Sciences, Hallie E Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR, 97331, USA

    Ashley Schuyler, Zainab Alidina, M. Margaret Dolcini & Joseph Catania

  2. School of Public Health, University of Michigan, Ann Arbor, MI, USA

    Gary Harper & Omar Jamil

  3. Indiana University School of Medicine, Indianapolis, IN, USA

    J. Dennis Fortenberry

  4. Oregon Social Learning Center, Eugene, OR, USA

    Ryan Singh

  5. University of California, San Francisco, San Francisco, CA, USA

    Lance Pollack

Authors
  1. Ashley Schuyler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zainab Alidina
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Margaret Dolcini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gary Harper
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Dennis Fortenberry
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ryan Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Omar Jamil
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lance Pollack
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Joseph Catania
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Ms. Schuyler took a lead role in conceptualizing the manuscript, analyzing and interpreting data, and writing the manuscript. Ms. Alidina and Dr. Singh participated in data analysis and interpretation as well as manuscript writing. Drs. Dolcini and Catania contributed to study conceptualization, data analysis and interpretation, and writing the manuscript. Drs. Dolcini, Harper, Fortenberry, Jamil, Pollack and Catania contributed to study design, participant recruitment, and data collection. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ashley Schuyler.

Ethics declarations

Conflict of interest

The authors have no conflict of interest or competing interests to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All procedures, consent materials, and interview protocols were approved by the University of Michigan IRB which served as the primary IRB for this project (IRB approval was ceded by Oregon State University to the University of Michigan IRB).

Informed Consent

Informed consent was obtained from all individual participants included in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices

Appendix A

Adapted social stigma items

The original Fortenberry scales were developed in young adult populations (male and female, multiple racial and sexual identities) in the U.S. at high risk for HIV/STIs and among adult samples in Kenya [40, 41]. In the U.S., higher levels of perceived social stigma were associated with lower rates of HIV and STI test-seeking. The Kenyan study found that stigma scores varied with social context, being higher and stable over time in rural vs. urban regions, suggesting that the Fortenberry measure may be sensitive to geographic differences in social norms regarding HIV-positive persons. The adapted scale factor analyzed into two factors, one reflecting self-image and the other HIV testing. Preliminary analyses indicated that both measures were significantly correlated (r = 0.40, p < 0.001), and the HIV testing stigma measure had a substantially larger association with PrEP awareness than the self-image measure. The HIV testing scale may reflect situationally-specific social stigma related to attending HIV testing clinics or treatment centers to access HIV testing (see table below). Our analyses suggest that the testing measure is assessing elements of social stigma beyond HIV testing specifically, and may instead represent social stigma related to revealing sexual orientation or HIV status in the social context of a health clinic. Therefore the testing stigma measure was selected for use in final analyses.

Appendix Table: HIV testing social stigma measure items

Getting tested for HIV would make me feel ashamed

I would feel embarrassed if a doctor asked me if I needed an HIV test

Getting myself tested for HIV would make me feel like I failed to take care of myself

I would find it embarrassing to ask for an HIV test

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schuyler, A., Alidina, Z., Dolcini, M.M. et al. Pre-Exposure Prophylaxis (PrEP) Dissemination: Adapting Diffusion Theory to Examine PrEP Adoption. AIDS Behav 25, 3145–3158 (2021). https://doi.org/10.1007/s10461-021-03345-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-021-03345-2

Keywords

Search

Navigation