Fordham RETI Fellow Addresses HIV Prevention & PrEP-Related Stigma

Dr. Kristen Underhill
Dr. Kristen Underhill

While an effective HIV prevention medication exists, the stigma surrounding stereotypes of the sexual promiscuity of users has undermined its preventative potential.

Fordham University Center for Ethics Education HIV and Drug Abuse Prevention Research Ethics Training Institute (RETI) Fellow Dr. Kristen Underhill, an associate research scholar at Yale University recently addressed this issue in a commentary piece in the American Journal of Public Health.

Oral antiretroviral preexposure prophylaxis (PrEP) – including the US Food and Drug Administration-approved once-daily pill Truvada – “has been praised for its multiple advantages as an adjunct to existing prevention methods (e.g., condoms) or in lieu of no protection,” as well as having high efficacy rates when used correctly, and “the potential to support conception among serodiscordant heterosexual couples.”

“We wrote this piece to address the popular view of PrEP users as promiscuous and irresponsible, because we are concerned that this stigma may undermine PrEP access and uptake,” Underhill and her co-author, Dr. Sarah K. Calabrese of the Yale University School of Public Health explained.

“In the paper, we consider not only how stigma may make clinicians less willing to prescribe PrEP, but also how internalized stigma might influence people’s perception of their own HIV risk, leading them to misjudge whether they could personally benefit from PrEP,” they continued.  “We also wanted to highlight the importance of sexual pleasure and relationship satisfaction in discussions about PrEP, since these are priorities for real-world users.”

While stigma and the use of PrEP were not the focus of Underhill’s research at the RETI, the commentary is very much in line with and relevant to the work of the Institute, and will serve as a resource for current and future fellows.

“Now that we know PrEP works to prevent HIV infection, we call for more research on how PrEP use can influence sexual pleasure, partnership opportunities, HIV-related anxiety, and relationship satisfaction overall,” said Calabrese and Underhill. “PrEP could have powerful secondary benefits beyond just the reduction of HIV risk, and we hope to explore these benefits as PrEP implementation proceeds.”


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