Author ORCID Identifier
Date of Award
Master of Public Health (MPH)
Dr. Sheryl Strasser
Dr. Ramona Bhatia
Human Immunodeficiency Virus (HIV) remains a salient public health priority in the United States. While Pre-Exposure Prophylaxis (PrEP) has existed for HIV prevention efforts since 2012, its effectiveness in epidemic control at the population level relies on the ability of vulnerable populations at increased risk of HIV to access this biomedical intervention. In the United States, most of the new HIV infections in 2021 were among gay and bisexual men, the majority of whom were Black or Hispanic/Latino. This disparity for Black and Latino men who have sex with men (BLMSM) is rooted in deeply entrenched social determinants of health. According to CDC preliminary data published in October 2023, estimates from 2022 suggest 94% of White people who could benefit from PrEP have been prescribed it, but only 13% of Black and 24% of Hispanic/Latino people who could benefit have been prescribed PrEP. To capture the social determinants in PrEP inequities, an environmental scan of published literature pertaining to PrEP access for BLMSM in the U.S. was conducted. The Social Ecological Model (SEM) was utilized to evaluate the root causes of PrEP inequities on four levels: microsystem (individual-level), mesosystem (interpersonal-level), exosystem (community-level), and macrosystem (structural-level).
The results from this scan demonstrate the following windows of opportunity across the four ecological levels to advance PrEP access for BLMSM in the U.S.: 1) Targeted and tailored educational materials to improve individuals’ perceptions about PrEP 2) PrEP communications delivered by the BLMSM community to eliminate stigma, 3) Provider-targeted LGBTQIA+ affirmative training that is linguistically appropriate with a focus on racial inequities to advance cultural competency and reduce racist biases in medical settings, and 4) Nationwide programs and policies aimed to reduce geographical disparities, alleviate healthcare costs, and address factors associated with immigrant status for foreign-born LMSM.
Fisher, Ryan, "PrEP Inequities Among Black and Latino MSM in the United States: Identifying Barriers and Opportunities Using a Social Ecological Model (SEM) Framework." , Georgia State University, 2024.
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