PrEP Barriers and Deterrents
The research was aimed at establishing barriers to adoption of PrEP for various high risk groups. The identified inhibitors included inadequate insurance cover, barriers associated with community re-entry, stigma, actual or perceived side effects and lack of awareness among providers. These barriers are discussed below in detail.
Inadequate insurance coverage
- A report, titled "Evolving models and Ongoing Challenges for HIV PrEP Implementation in the US" states that "inadequate insurance coverage, including lack of insurance, high copayments and/or deductibles for office visit and laboratory procedures, contributes to disparities in PrEP use".
- According to the report, close to 26 million Americans are uninsured. The high cost of PrEP drugs implies that the access to these drugs will remain a challenge for this population, hence inhibiting the implementation.
- The risk group here according to NCBI include 15% of the Black, 28% of Hispanic/Latino, 18-24% of the lesbian, gay, bisexual, transgender and queer population who are estimated to be uninsured.
- To overcome this barrier, health policies allowing equal access to affordable and high quality insurance throughout the US for all population groups are needed.
- According to the report, some states and cities have "created special PrEP service reimbursement programs, such as New York State’s Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) in order to address the issue".
Barriers associated with community re-entry
- In a study that interviewed 26 MSM who were incarcerated to explore their knowledge on PrEP, a number of barriers related to incarceration were discussed by participants.
- These included lack of housing, transportation and re-incarceration.
- On lack of transportation as a concern that may affect PrEP uptake, participants cited that loss of personal car by confiscation and the expiration of a driver's license may deny them the ability to get to places where they could get the drugs.
- Many participants noted that worries of lack of a place to live coupled with other compounding hardships like getting ID, going back to welfare and many other different things to be done during community re-entry would deprioritize PrEP.
- The highlighted barriers affected the incarcerated, and also MSM with recent incarceration.
- A solution is to "consider establishing PrEP access prior to release through referral to a PrEP clinic or prescribing PrEP shortly before discharge".
- PrEP-related stigma are fears about others noticing the use of PrEP by an individual.
- People are concerned about their family members seeing PrEP fees on their insurance bill, while others are concerned about communities discovering that they are taking PrEP.
- Such people avoid taking PrEP or discontinue the drugs.
- The stigma barrier affects the general population and Young Sexual Minority Men.
- To curd this, providers "must work to create open and non-judgmental spaces in which patients can discuss sexual behaviors without the fear of stigma".
Actual or perceived side effects
- In a study conducted in Mississippi, two participants are reported to have experienced or perceived side effects that caused them to discontinue PrEP.
- One stopped PrEP after experiencing nightmares and another one experienced headache and nausea that lasted the whole day.
- Anticipated side effects were a major concern for the Mississippi study participants and were a "factor[s] undermining retention in PrEP".
- Some participants reported using PrEP amid fears for their kidneys and livers.
- The same were reported to be among barriers to PrEP among Men who have Sex with Men (MSM).
- This is a factor that affects the general population as well as MSM.
- A study on barriers to care recommends keeping a close eye on creatinine levels in the kidneys and lab scheduling to check if there are effects on the kidneys and take necessary next steps.
Lack of awareness among providers
- A study conducted on online posts reported that individual experiences with poorly informed providers was a barrier to PrEP.
- It states that lack of PrEP awareness among providers made it difficult for users to adhere to PrEP. One reason is the perception of PrEP users being promiscuous.
- According to the study, this barrier was reported to affect gay, bisexual and other MSM groups.
- The study recommends social support through online spin-off support group pages where user can share experiences, both positive and negative, and passionate PrEP advocates can discuss the positive impacts of PrEP.
- Another recommended facilitator was to increase trust in healthcare providers through training, and to ease access of PrEP through non-traditional prescription methods such as online ordering.