Date of Award

January 2025

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

E. Jennifer Edelman

Abstract

Background: Pre-exposure Prophylaxis (PrEP) for HIV prevention is recommended for people who inject drugs (PWID), yet implementation remains low. Discrimination and medical mistrust have been identified as barriers to PrEP uptake and HIV care among other at-risk groups, but have not been studied specifically among PWID. This study assessed the prevalence of, and characteristics associated with, drug use discrimination and medical mistrust among PWID; and explored whether either related to PrEP readiness.

Methods: We analyzed baseline data from a randomized controlled trial operating at six community-based sites in the northeastern US serving individuals with opioid use disorder. Medical mistrust was assessed using an adapted 5-point Group-Based Medical Mistrust Scale (GBMMS), including physician mistrust items. Participant characteristics, discrimination in healthcare settings, and PrEP readiness measures were described overall and by medical mistrust level where higher GBMMS scores indicated increased mistrust.

Results: Between October 2021 and March 2025, 264 participants completed the baseline assessment. Median [IQR] age was 41 [35-50] years. Participants were predominantly White (61.2%), male (66.2%), and had injected drugs in the prior 6 months (55.4%). Half (50.4%) reported experiencing any kind of discrimination and 46.2% reported drug use discrimination specifically. Of 262 participants who completed the GBMMS, the mean (SD) overall score was 2.8 (0.8) and 37.1% had scores suggesting high levels of medical mistrust (score ≥3). Both any and drug use discrimination were associated with high medical mistrust (both p values < 0.001). Most participants endorsed PrEP awareness (76.9%) and thought they should begin taking PrEP, but did not feel ready to do so (41.1%) at time of assessment. High medical mistrust was associated with PrEP stigma (p < 0.05) and elevated next year (p < 0.02) and lifetime (p < 0.001) HIV risk perception.

Conclusion: Drug use discrimination and medical mistrust were prevalent in this sample, and significantly associated with one another. Though most participants were aware of PrEP and thought they should take the medication, overall readiness was low. Further research is needed to determine whether drug use discrimination and medical mistrust are barriers to PrEP uptake among PWID, and how these factors might be mitigated.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/01/2028

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