Qualitative Methods for Studying Pre-Exposure Prophylaxis (PrEP) Among Young Queer Men of Color in the US: A Literature Review

Author(s)

Gerald Lemmon

Faculty Mentor(s)

Griff Tester (Sociology)

Abstract

In the U.S., gay and other men who have sex with men (G/MSM), especially young Black and Latino men of color, are disproportionately impacted by the human immunodeficiency virus (HIV), representing a large percentage of the HIV-positive population and accounting for the bulk of new infections. Pre-exposure prophylaxis (PrEP) is a highly effective HIV-prevention method that includes HIV-negative individuals taking a daily anti-retroviral medication and visiting a medical provider quarterly to test for sexually transmitted infections. Since 2012, when the FDA approved the fixed-dose combination of tenofovir disproxil fumarate and emtricitabine (TDF-FTC), or Truvada, for PrEP, uptake has been increasing, but is still low, and access and use disparities exist among racial and ethnic minority G/MSM. The aim of this systematic literature review is to identify useful qualitative methods for recruiting and studying PrEP among queer men of color. To do this, I examine scientific articles, published between 2010 and 2020, that meet the following criteria: (1) Focus on HIV-prevention, specifically PrEP; (2) Use samples of G/MSM; and (3) Use qualitative data collection approaches. My research questions are: (1) What strategies do PrEP researchers use to recruit and qualitatively study G/MSM? (2) How do the approaches used, and methodological limitations discussed, differ among studies using samples that include white G/MSM and those focused exclusively on G/MSM of color? The findings of this review will help researchers identify methodological barriers to accessing these understudied populations and develop strategies for overcoming these difficulties.

Keywords: PrEP (Pre-Exposure Prophylaxis), HIV-Prevention, Methods

Presentation

8 thoughts on “Qualitative Methods for Studying Pre-Exposure Prophylaxis (PrEP) Among Young Queer Men of Color in the US: A Literature Review”

  1. Super rad presentation, Gerald! You’re superbly well spoken and the information is super easy for me to to understand even though I have next to no connection or previous experience with these topics. I know the COVID pandemic has messed with a lot of different projects, but could you please explain to me more how it changed yours? Did you mean to start as a lit review or did you intend to do outreach and eventually just had to come to lit review to accommodate the current conditions? Either way, rocking project and I’m stoked to see what future research you’ll do!

    1. Hi Henry,
      The original project identified the existing HIV disparities as mentioned at the beginning of the presentation. Since there was an original lack of existing data on Black and Hispanic GMSM, there was a need to perform research within these areas. This was especially true of rural spaces where there was also a lack of data that has been collected in these areas as they mostly consist of data from metropolitan areas. I identified that within the Yakima Valley (Yakima County) that the rate of HIV infections doubled between 2016 and 2017 and there was no information stating why that occurred so my mentor and I had planned to recruit 10 Latinx GMSM in the Yakima Valley area and interview them regarding their knowledge perceptions, attitudes, and beliefs on the medication. With this data, I would perform semi-structured interviews where I would code and analyze the data to code for emergent themes and trends that would be discussed in my final project. With COVID-19, we ran into challenges with recruitment of participants, plus since the pandemic started in Spring of 2020 we did not get to go into the Yakima Community to advertise our study, plans, and collaborations. Once I started my SURE grant period, we still had trouble recruiting participants since they are a very hard to reach population–this is why we justified snowball sampling in an effort to get participants for our students when we would go going into the study and interviews (e.g. asking first interviewer if they have friends of this particular identity). As time went on, we attempted to interview stakeholders and key informants who may be helpful in helping us recruit our participants. We were able to talk with one of these spaces, but the culture of the area and some of the people and resources we reached out refused and informed us that they could not assist and participate in our research. As time went on, we starting looking at the feasibility based on location to recruit participants in a larger range of areas in rural settings which included Yakima Valley, Benton County, and Walla Walla County. Nevertheless, our struggles still continued to occur. It was from this that we decided to perform a methodological literature review that would be beneficial for me to continue this research within my graduate programs from recruitment strategies.
      Let me know if you have any more questions and thank you for asking!
      Gerald Lemmon

  2. Gerald,
    I enjoyed your presentation, and really appreciate seeing how you took a study that you wanted to conduct via semi-structured interviewing and applied it to a literature review while still showcasing the research study purpose, and public health implications. This was really nice for me to see as I think about my own research prospectus. Your thorough response to Henry helped to fill in an underlying question that I had as far as the direction of the study outside of your review, or ideal study design. Between the years 2010 and 2020 did you find within your literature review any mitigation efforts that help to breakdown barriers to accessing PrEP, and social stigmas? thus allowing for more equitable access to care and resources?
    Well done!

    1. Hi Jaclyn,
      Great questions you ask here!
      Let me start by saying that my specific project focuses on the efforts that researchers can take to mitigate some of those experiences that come up within the recruitment and collection of data regarding PrEP and gay men who have sex with men as a general population. When it comes to breaking down those barriers, we want to revisit some of the key literature review that I used to talk about the barriers that do exist and thinking about how we can address them. The literature informs us that some of the core issues when it comes to accessing PrEP include transportation, affordability of the medication, reducing the stigma within uptake of the medication interacting with healthcare providers, and so much more. Washington states has taken one step to help reduce these barriers in uptake of the medication based on Washington State PrEP Drug Assistance Program (WA PrEP DAP) which allows paperwork to be completed with the quarterly STI tests to patients and they can acquire access to PrEP for free through using this process. Nevertheless, there has been some expressing of concerns about this because scholars and those practicing healthcare ask “isn’t this hostile to an extent” because we are asking people to continuously report the same information which can often be personal information such as sex partners which can bring discomfort to the one who is attempting to seek free access to PrEP. Besides this, there are also some literature articles such as Garcia and colleagues (2016) study where they use a confidentiality certificate to ensure to their participants that their information will remain private. This social stigma as reported in this article and many others is not only acquired through attempting to take up the medication, but also through the interactions that are had in research, the clinic setting and in sexual encounters. One of the keys that you could take away in that regard is the need for education and knowledge because this helps people understand what the medication is and what it does. There is aspect that is emphasis in Garcia and colleagues (2016) that emphasis a point that talk about in this research realm and that is moving beyond talking about the issue as high risk. We need to use testimonials and storytelling narratives to listen to the experiences PrEP users have if we are going to start changing the narrative about how we understand the medication, ourselves, and relations with others at the intersections of race and gender for example.
      I hope this provides you with some insight into the questions you asked! Let me know if you have any other questions!
      All the best,
      Gerald Lemmon

      References:

      Garcia, J., Parker, C., Parker, R., Wilson, P., Philbin, M. & Hirsch, J. (2016). Psychosocial implications of homophobia and HIV stigma in social support networks: Insights for high-impact HIV prevention among Black men who have sex with men. Health and Education Behavior, 43(2), 217-225. DOI: 10.1177/1090198115599398.

      Garcia, J., Parker, R., Parker, C., Wilson, P., Philbin, M. & Hirsch, J. (2016). The limitations of ‘Black MSM’ as a category: Why gender, sexuality, and desire still matter for social and biomedical HIV prevention methods. Global Public Health, 11(7-8), 1026-48. DOI: 10.1080/17441692.2015.1134616

      1. Gerald,

        Thank you for your detailed response, this answers my questions and gives me a broader knowledge base and resources! I am very appreciative of your time, and I wish you the best as you pursue your academic and career goals. You have already made a great contribution to the field! Thank you!

  3. Allyson Rogan-Klyve

    Excellent work on the project and very well explained in your presentation. Wishing you all the best at Merced next year!

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