DISPARITIES IN PRE-EXPOSURE PROPHYLAXIS AWARENESS AMONG WOMEN: A SYSTEMATIC REVIEW OF THE LITERATURE AND LATENT CLASS ANALYSIS OF SYNDEMIC RISK FACTORS

Simple item page
dc.contributor.advisorCurbow, Barbaraen_US
dc.contributor.authorStubbs, Leandra Nicoleen_US
dc.contributor.departmentPublic and Community Healthen_US
dc.contributor.publisherDigital Repository at the University of Marylanden_US
dc.contributor.publisherUniversity of Maryland (College Park, Md.)en_US
dc.date.accessioned2021-02-13T06:37:39Z
dc.date.available2021-02-13T06:37:39Z
dc.date.issued2020en_US
dc.description.abstractWhile rates of HIV infection have declined among women in recent years, women still account for 19% of all new infections each year in the United States (US). Sociodemographic disparities remain with much of the burden falling on Black adult women aged 25-44. Ongoing transmission of HIV in this population has mostly resulted from heterosexual contact and prior studies have identified interpersonal and sociocultural factors that impede a woman’s choice to engage in safe sex and prevent HIV acquisition. With the debut of pre-exposure prophylaxis (PrEP), an FDA-approved once-daily pill to prevent HIV transmission, researchers believed that this user-controlled method would be an innovative method in reducing HIV in this subpopulation. However, since its release in 2012, there has been insufficient knowledge of PrEP among women in the U.S, resulting in slow and disproportionate uptake of PrEP in this population. While we know the clinical efficacy of PrEP, more understanding of the behavioral, social, and structural factors that impede PrEP awareness among women is important in the dissemination of PrEP-related information and subsequent use.In this dissertation, I took an exploratory approach to: a) identify awareness, knowledge, barriers and facilitators of PrEP use among US-based women through a systematic review; b) identify factors associated with PrEP awareness among female participants in the 2018 Community Health Survey; and c) explore how the presence of multiple deleterious factors can create distinct subgroups of women and further exacerbate disparities in PrEP awareness. In Paper 1, the systematic review of PrEP knowledge among Black/African American women identified 12 articles with findings disaggregated by both race and gender. Primary findings included gaps in PrEP knowledge; acceptability and willingness to use once informed of PrEP; perceived disadvantages as a result of exclusion in clinical trials and early dissemination; and social, structural, and institutional barriers to engagement in the PrEP care continuum. Papers 2 and 3 leveraged data from the 2018 Community Health Survey, a cross-sectional telephone survey of randomly selected adults aged 18 and older from all five boroughs of New York City. In Paper 2, 36% of a female subsample (N=2,295) were aware of PrEP at time of survey. As a result of multinomial linear regression, nine variables were significantly associated with PrEP awareness: nativity, education level, recent HIV test, number of sex partners, IPV, age, race/ethnicity, general health, and prior incarceration. In Paper 3, latent class analysis was used to identify distinct classes of women with varied responses to behavioral and structural variables. The adjusted item-response probabilities resulted in three distinct profiles of women: high resource and low risk group (39%), low resource and moderate risk group (33%), and moderate resource and high-risk group (28%). Key differences between groups include PrEP awareness, perceived health, count of sexual partners, and neighborhood poverty level. These findings have key implications for the way in which PrEP is marketed to women. Future studies should consider the importance of intersectionality and the social and structural context through which women engage with HIV prevention materials and promotional campaigns.en_US
dc.identifierhttps://doi.org/10.13016/tjgm-aaui
dc.identifier.urihttp://hdl.handle.net/1903/26750
dc.language.isoenen_US
dc.subject.pqcontrolledPublic healthen_US
dc.subject.pqcontrolledBehavioral sciencesen_US
dc.subject.pquncontrolledHealth Disparitiesen_US
dc.subject.pquncontrolledHIVen_US
dc.subject.pquncontrolledPrEPen_US
dc.subject.pquncontrolledPreventionen_US
dc.subject.pquncontrolledWomenen_US
dc.titleDISPARITIES IN PRE-EXPOSURE PROPHYLAXIS AWARENESS AMONG WOMEN: A SYSTEMATIC REVIEW OF THE LITERATURE AND LATENT CLASS ANALYSIS OF SYNDEMIC RISK FACTORSen_US
dc.typeDissertationen_US

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Stubbs_umd_0117E_21301.pdf
Size:
860.09 KB
Format:
Adobe Portable Document Format
Download

Collections

UMD Theses and Dissertations
Behavioral & Community Health Theses and Dissertations