{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T14:24:25Z","timestamp":1793802265409,"version":"4.6.1"},"reference-count":25,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2020,6,12]],"date-time":"2020-06-12T00:00:00Z","timestamp":1591920000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"University of Chicago Metcalf Grant"},{"name":"University of Chicago Summer International Travel Grant"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2020,2,29]]},"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>UK Black African\/Black Caribbean women remain disproportionately affected by HIV. Although oral pre-exposure prophylaxis (PrEP) could offer them an effective HIV prevention method, uptake remains limited. This study examined barriers and facilitators to PrEP awareness and candidacy perceptions for Black African\/Black Caribbean women to help inform PrEP programmes and service development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using purposive sampling through community organisations, 32 in-depth, semi-structured interviews were conducted with Black African\/Black Caribbean women living in London and Glasgow between June and August 2018. Participants (aged 19\u201363) included women of varied HIV statuses to explore perceptions of sexual risk and safer sex, sexual health knowledge and PrEP attitudes. A thematic analysis guided by the Social Ecological Model was used to explore how PrEP perceptions intersected with wider safer sex understandings and practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four key levels of influence shaping safer sex notions and PrEP candidacy perceptions emerged: personal, interpersonal, perceived environment and policy. PrEP-specific knowledge was low and some expressed distrust in PrEP. Many women were enthusiastic about PrEP for others but did not situate PrEP within their own safer sex understandings, sometimes due to difficulty assessing their own HIV risk. Many felt that PrEP could undermine intimacy in their relationships by disrupting the shared responsibility implicit within other HIV prevention methods. Women described extensive interpersonal networks that supported their sexual health knowledge and shaped their interactions with health services, though these networks were influenced by prevailing community stigmas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Difficulty situating PrEP within existing safer sex beliefs contributes to limited perceptions of personal PrEP candidacy. To increase PrEP uptake in UK Black African\/Black Caribbean women, interventions will need to enable women to advance their knowledge of PrEP within the broader context of their sexual health and relationships. PrEP service models will need to include trusted \u2018non-sexual health-specific\u2019 community services such as general practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2020-054457","type":"journal-article","created":{"date-parts":[[2020,6,12]],"date-time":"2020-06-12T17:20:28Z","timestamp":1591982428000},"page":"349-354","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":50,"title":["Risk perception, safer sex practices and PrEP enthusiasm: barriers and facilitators to oral HIV pre-exposure prophylaxis in Black African and Black Caribbean women in the UK"],"prefix":"10.1136","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1720-2365","authenticated-orcid":false,"given":"Sarah E","family":"Nakasone","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1242-5992","authenticated-orcid":false,"given":"Ingrid","family":"Young","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia S","family":"Estcourt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josina","family":"Calliste","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6239-5616","authenticated-orcid":false,"given":"Paul","family":"Flowers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Ridgway","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Shahmanesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,6,12]]},"reference":[{"key":"2024092304150693000_96.5.349.1","unstructured":"Nash S , Desai S , Croxford S , et al . Progress towards ending the HIV epidemic in the United Kingdom: 2018 report. London: Public Health England, 2018."},{"key":"2024092304150693000_96.5.349.2","unstructured":"Brown A , Czachorowski M , Davidson J , et al . HIV testing in England: 2017 report. London: Public Health England, 2017."},{"key":"2024092304150693000_96.5.349.3","unstructured":"Stokes P . 2011 census: key statistics and quick statistics for local authorities in the United Kingdom\u2014Part 1. Office for National Statistics, 2013. https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/populationandmigration\/populationestimates\/datasets\/2011censuskeystatisticsandquickstatisticsforlocalauthoritiesintheunitedkingdompart1"},{"key":"2024092304150693000_96.5.349.4","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2014-005717","article-title":"Barriers to uptake and use of pre-exposure prophylaxis (PreP) among communities most affected by HIV in the UK: findings from a qualitative study in Scotland","volume":"4","author":"Young","year":"2014","journal-title":"BMJ Open"},{"key":"2024092304150693000_96.5.349.5","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s12119-012-9142-5","article-title":"\u201cGetting to know\u201d: exploring how urban African American women conceptualize safer and risky sexual behaviors","volume":"17","author":"Anaebere","year":"2013","journal-title":"Sex Cult"},{"key":"2024092304150693000_96.5.349.6","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001145"},{"key":"2024092304150693000_96.5.349.7","unstructured":"Sullivan A . PrEP impact trial: a pragmatic health technology assessment of PrEP and implementation, 2019. Available: https:\/\/www.prepimpacttrial.org.uk\/protocol"},{"key":"2024092304150693000_96.5.349.8","unstructured":"National HIV PrEP Coordinating Group . Implementation of HIV PreP in Scotland: first year report. Health Protection Scotland and Information Services Division, 2019."},{"key":"2024092304150693000_96.5.349.9","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-13-482","article-title":"Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics","volume":"13","author":"Baral","year":"2013","journal-title":"BMC Public Health"},{"key":"2024092304150693000_96.5.349.10","unstructured":"Centers for Disease Control and Prevention . The Social-Ecological Model: a framework for prevention, 2019. 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Available: https:\/\/sophiaforum.net\/index.php\/women-and-prep\/ [Accessed 20 Aug 2019]."},{"key":"2024092304150693000_96.5.349.13","unstructured":"ATLAS.ti . 8 ATLAS.ti Scientific Software Development GmbH. 2019."},{"key":"2024092304150693000_96.5.349.14","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2024092304150693000_96.5.349.15","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(17)30183-2","article-title":"U=U taking off in 2017","volume":"4","year":"2017","journal-title":"Lancet HIV"},{"key":"2024092304150693000_96.5.349.16","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2014.0142"},{"key":"2024092304150693000_96.5.349.17","first-page":"1","article-title":"Perceived advantages and disadvantages of using pre-exposure prophylaxis (PrEP) among sexually active black women: an exploratory study","volume":"3","author":"Bond","year":"2016","journal-title":"J Black Sex Relatsh"},{"key":"2024092304150693000_96.5.349.18","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1521\/aeap.2018.30.5.382","article-title":"Exploring gender differences in PrEP interest among individuals testing HIV negative in an urban emergency department","volume":"30","author":"Ridgway","year":"2018","journal-title":"AIDS Educ Prev"},{"key":"2024092304150693000_96.5.349.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001613","article-title":"Early experiences implementing pre-exposure prophylaxis (PrEP) for HIV prevention in San Francisco","volume":"11","author":"Liu","year":"2014","journal-title":"PLoS Med"},{"key":"2024092304150693000_96.5.349.20","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2015-052224"},{"key":"2024092304150693000_96.5.349.21","doi-asserted-by":"publisher","DOI":"10.1080\/13691050802560336"},{"key":"2024092304150693000_96.5.349.22","doi-asserted-by":"crossref","first-page":"19","DOI":"10.5130\/lns.v15i2.2205","article-title":"Discourses in interaction: the intersection of literacy and health research internationally","volume":"15","author":"Green","year":"2007","journal-title":"LNS"},{"key":"2024092304150693000_96.5.349.23","unstructured":"Young I , Valiotis G . Strategies to support HIV literacy in the roll-out of pre-exposure prophylaxis in Scotland: findings from qualitative research with clinical and community practitioners. BMJ Open Forthcoming."},{"key":"2024092304150693000_96.5.349.24","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/dah609"},{"key":"2024092304150693000_96.5.349.25","doi-asserted-by":"crossref","first-page":"872","DOI":"10.2105\/AJPH.2017.303704","article-title":"Safe sex in the 1970s: community practitioners on the eve of AIDS","volume":"107","author":"Blair","year":"2017","journal-title":"Am J Public Health"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2020-054457","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T07:16:19Z","timestamp":1727075779000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2020-054457"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,12]]},"references-count":25,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,7,16]]},"published-print":{"date-parts":[[2020,8]]}},"alternative-id":["10.1136\/sextrans-2020-054457"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2020-054457","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,12]]}}}