{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T20:32:32Z","timestamp":1786393952726,"version":"build-2736575974"},"reference-count":62,"publisher":"Guilford Publications","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["AIDS Education and Prevention"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>HIV remains a critical global public health concern. While no cure exists, treatments like antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) effectively reduce transmission rates. However, PrEP uptake is low, especially in areas facing stigma and misinformation, such as the southern United States, where high HIV stigma further hinders compliance. This study examined PrEP-related knowledge, attitudes, and prescribing behaviors among 179 nurse practitioners (NPs) in one southeastern state. Results indicated significant gaps in PrEP knowledge. Qualitative interviews highlighted stigma rooted in religious and regional contexts and emphasized the need for better education and provider-patient communication. These findings confirm that providers with PrEP knowledge and tools to reduce stigma may foster an increase in PrEP uptake in high-need areas.<\/jats:p>","DOI":"10.1521\/aeap.2026.38.4.335","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T20:02:36Z","timestamp":1786392156000},"page":"335-346","source":"Crossref","is-referenced-by-count":0,"title":["Knowledge, Culture, and Communication in HIV Prevention: A Mixed-Methods Study of Nurse Practitioners\u2019 Roles in Pre-exposure Prophylaxis (PrEP) Uptake in Rural and Underserved Areas"],"prefix":"10.1521","volume":"38","author":[{"given":"Jarrod E.","family":"Gant","sequence":"first","affiliation":[{"name":"The Mississippi State Department of Health, Office of STD\/HIV, Jackson, Mississippi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S.","family":"Miller","sequence":"additional","affiliation":[{"name":"University of Mississippi Medical Center, School of Nursing, Jackson, Mississippi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth G.","family":"Franklin","sequence":"additional","affiliation":[{"name":"University of Mississippi Medical Center, School of Health Related Professions, Jackson, Mississippi"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"377","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-019-02607-4"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1080\/15381501.2020.1712291"},{"issue":"11","key":"ref3","first-page":"1351","volume":"29","author":"Cahill S.","year":"2017","journal-title":"Care"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-020-00533-y"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-019-02671-w"},{"key":"ref6","unstructured":"Centers for Disease Control and Prevention. (2019). HIV in the southern United States, https:\/\/stacks.cdc.gov\/view\/cdc\/92279"},{"key":"ref7","unstructured":"Centers for Disease Control and Prevention. (2024a). Estimated HIV incidence and prevalence in the United States, 2018-2022 (HIV Surveillance Supplemental Report 2024; 29 [No. 1]). https:\/\/www.cdc.gov\/hiv-data\/nhss\/estimated-hiv-incidence-and-prevalence.html"},{"key":"ref8","unstructured":"Centers for Disease Control and Prevention. (2024b). Undetectable = Untransmitt able, https:\/\/www.cdc.gov\/hiv\/data-research\/facts-stats\/index.html"},{"key":"ref9","unstructured":"Centers for Disease Control and Prevention. (2025). Clinical guidance for PrEP. https:\/\/www.cdc.gov\/hivnexus\/hcp\/prep\/index.html"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2017.1384534"},{"key":"ref11","volume-title":"Under Trump administration, continued full coverage of HIV PrEP drugs uncertain","author":"Cohen J. 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HIV Surveillance Report (HIV Surveillance 34). https:\/\/stacks.cdc.gov\/view\/cdc\/149071"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.3390\/sexes5030023"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.21167"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2018.0121"},{"key":"ref19","unstructured":"Emory University. (2025). AIDSVu releases 2024 PrEP use data showing growing use across the U.S. AIDSVu. https:\/\/aidsvu.org\/news-updates\/aidsvu-releases-2024-prep-use-data-showing-growing-use-across-the-u-s\/"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1916753"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-018-2081-x"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1258\/ijsa.2009.009255"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2022.2029816"},{"key":"ref24","unstructured":"HIV.gov. (2025, February 21). Data & trends: U.S. statistics. https:\/\/www.hiv.gov\/hiv-basics\/overview\/data-and-trends\/statistics"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2017.0082"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1521\/aeap.2017.29.4.315"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Jenness, S. M., Maloney, K. M., Smith, D. K., Hoover, K. W., Goodreau, S. M., Rosenberg, E. S., Weiss, K. M., Liu, A. Y., Rao, D. W. & Sullivan, P. S. (2018). Addressing gaps in HIV preexposure prophylaxis care to reduce racial disparities in HIV incidence in the United States [Preprint]. bioRxiv. https:\/\/doi.org\/10.1101\/249540","DOI":"10.1101\/249540"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2019.305389"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.outlook.2021.12.008"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-020-02807-3"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Mahaffey, C. C., Jeremiah, R. D., O'Neil, A. M., Clement, D. N., Cava, L., Ruiz, F. R., Hubach, R. D. & Stevens-Watkins, D. (2025). Navigating access to pre-exposure prophylaxis (PrEP): Black men who have sex with men (BMSM) voices living in HIV hotspots. Journal of Racial and Ethnic Health Disparities. Advance online publication, https:\/\/doi.org\/10.1007\/s40615-025-02652-x","DOI":"10.1007\/s40615-025-02652-x"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1186\/s13722-025-00584-9"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-020-01295-0"},{"key":"ref34","unstructured":"McNamara, M., Harsono, D., Edelman, E.J., Norwood, A., Hill, S., Paltiel, D., Gonsalves, G. & Alstott, A. (2023). Braidwood misreads the science: The PrEP mandate promotes public health for the entire community. https:\/\/law.yale.edu\/sites\/default\/files\/documents\/pdf\/prep_report_final_feb_l3_2023_rev.pdf"},{"key":"ref35","unstructured":"National Institute of Allergy and Infectious Diseases. (2019, May 21). HIV undetectable = Untransmittable (U =U), or treatment as prevention, https:\/\/www.niaid.nih.gov\/diseases-conditions\/treatment-prevention"},{"key":"ref36","unstructured":"National Institutes of Health. (2019, December 18). Initiation of antiretroviral therapry. https:\/\/clinicalinfo.hiv.gov\/en\/guidelines\/hiv-clinical-guidelines-adult-and-adolescent-arv\/initiation-antiretroviral-therapy"},{"key":"ref37","unstructured":"National Institutes of Health. (2021, August 10). Pre-exposure prophylaxis (PrEP). https:\/\/hivinfo.nih.gov\/understanding-hiv\/fact-sheets\/pre-exposure-prophylaxis-prep"},{"key":"ref38","unstructured":"National Institutes of Health. (2024, February 21). Long-acting HIV treatment demonstrates efficacy in people with challenges taking daily medicine as prescribed, https:\/\/www.nih.gov\/news-events\/news-releases\/long-acting-hiv-treatment-demonstrates-efficacy-people-challenges-taking-daily-medicine-prescribed"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12916"},{"issue":"2","key":"ref40","volume":"8","author":"O'Reilly-Jacob M.","year":"2025","journal-title":"JAMA Network Open"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12723"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1007\/s13178-023-00825-z"},{"issue":"3","key":"ref43","first-page":"ofadl39","volume":"10","author":"Paltiel D.","year":"2023","journal-title":"Braidwood Management v. Becerra. Open Forum Infectious Diseases"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(19)30230-9"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1016\/j.jana.2012.08.007"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2019.0189"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1007\/s11908-019-0685-6"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13121374"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-018-2375-z"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.1007\/s10900-017-0325-8"},{"issue":"2","key":"ref51","first-page":"1","volume":"4","author":"Reif S.","year":"2018","journal-title":"Journal of HIV and AIDS"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.1177\/21501319221147254"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2022.306793"},{"key":"ref54","doi-asserted-by":"publisher","DOI":"10.37765\/ajmc.2024.89654"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.1016\/j.jana.2017.11.002"},{"key":"ref56","volume-title":"Timeline of the HIV and AIDS epidemic","author":"United States Department of Health and Human Services"},{"key":"ref57","volume-title":"Postexposure prophylaxis","author":"United States Department of Health and Human Services","year":"2025"},{"key":"ref58","volume-title":"FDA approves first injectable treatment for HIV pre-exposure prevention","author":"United States Food and Drug Administration","year":"2021"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.5042"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2017.01.025"},{"key":"ref61","unstructured":"World Health Organization. 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