Are we ready?! Part 1: Community and Provider Knowledge of Biomedical Prevention

Do you remember the first time you used the Internet?  100 hours free from AOL?!?!  Sweet.  Ok, I’m signed on… apparently I can chat with random men or go to MTV.com. After about 10 minutes of “using” this new technology, I was ready to call my friends on the portable phone, play some minesweeper, or listen to Wham! on my Walkman.  Some of us are early adapters, and some of us (yours truly) will wait for version 5.0 to even think about it.

We are all used to the fast pace of new communication technology by now.  Every day there’s an upgrade, a new way of sharing what kind of smoothie we are eating, and a new way of finding a date.

We are not used to the fast pace of new medical and HIV prevention technology.  Although biomedical prevention for HIV has been a part of our world for years, we are more recently in the midst of a larger awakening as a field.  But like any other new technology, whether it be Google glasses or accordion condoms, success falls on three factors: Do people want it? Can people get it? Can people afford it? These questions are very important to achieving an AIDS Free Generation.

When we say Biomedical HIV Prevention, what we are talking about is a range of technologies the reduce the chance of getting or spreading HIV by targeting our bodies.  For instance, HIV treatment drugs, that have in the past been used only with people living with HIV, are now being used to help prevent HIV.  Say one is going on a vacation and knows that some sexy fun is to be had with many strangers.  Risky? Yes.  Now, instead of using condoms (which may not happen all the time) as the only method to prevent HIV and other STDs, one can also take a pill (Truvada) once a day for 10 days before the trip, and this will increase the chance that one will come back happy and healthy and HIV free. This type of biomedical prevention is called PrEP – or Pre-exposure prophylaxis, because you take the pill before the potential exposure.  This is just one example of biomedical prevention; you can also take a pill after you think you might have been exposed to lower the chance of getting HIV (PEP – or post-exposure prophylaxis). Finally, recent research has shown that when people who are living with HIV are on HIV treatment medication, it is less likely that their sex partner will get HIV (this is called Treatment as Prevention). There are plenty other tools like these in the pipeline, like microbicides (or gels that have HIV medication in them to help prevent HIV).

At the Commission, we are working with our partners in the Be the Generation Bridge Project and we have spent the year conducting workshops, Town Halls, and webinars to increase awareness and knowledge about biomedical HIV prevention in Latino communities and the health providers who work with them.  As part of this, we wanted to see what the baseline knowledge around things such as pre-exposure prophylaxis (PrEP), Post-exposure prophylaxis (PEP), Treatment as prevention, microbicides, vaccines and clinical trials. This goes back to the questions we asked earlier about adopting new tools – Do people know what it is?  When the internet was first invented by Al Gore (kidding!) did people know what it was? How to use it? What it was for?  No.  It took time. Similarly, time is needed to understand what do people already know? and what do they need to know in order to adopt it?

Here we will summarize our preliminary findings from surveys collected in New York City, San Juan, PR, Philadelphia, and Chapel Hill, NC that try to answer these question.  In a follow up article, we will look at attitudes around these topics as well.

To understand baseline knowledge (before we did any workshops or Town Halls), we asked 18 true-false questions about PrEP, PEP, Treatment as Prevention, microbicides, vaccines and biomedical research.  Questions were adapted from the BTG Bridge survey; you can have a look at the questions and answers here.

Overall, the total “knowledge score” (adding together correct answers) was 10.4 out of 18, or 58%.  The knowledge range was wide with some people not getting any answers correct and some getting them all correct.  Were there any differences between community members and service providers? Men and women? Gay and straight? There were no statistically significant differences between such groups.

Let’s dig a little deeper: as I mentioned above, there was a pretty broad range of knowledge scores. So, which types of questions are people getting right and which types are people getting wrong? This will help us understand where we need to focus our future education and messaging.  The table to the right shows the topic of each question in the left column, the actual question, the percentage correct, and the percent of people that simply checked “don’t know” in the right column.  “Don’t know” is counted as incorrect.  We included this to help gauge where people are really just feeling in the dark.

Data1Notice that above the grey line, things are going pretty well. A majority of people know the answers and a small percentage felt like they just “don’t know.”  If we go through and see what kind of topics people are pretty familiar with, we see that it seems to center around “old news” – things about maternal to child transmission (since 1994) and more around aspects of engaging in clinical research in general.  There is one “new news” piece in here around Treatment as Prevention (the last one before the grey line) however; note that the question doesn’t use that term specifically.  Also, note that the least correct answer (the very last one at the bottom of the chart) does use the term “Treatment as Prevention” and very few people got this correct, suggesting that the while the concept may be understood, the term itself is not.  Marketing!

Now look below the grey line.  Here we see a big jump in people that just “don’t know” and a gradual decline in correct answers. For questions about microbicides and vaccines (two areas that researchers are investigating, but there isn’t a product on the market), almost equal amounts of people felt they couldn’t guess as gave the correct answer. These topics where people are less certain and less correct in their knowledge around biomedical prevention, include largely microbicides, PrEP, and how vaccines work.  We can think of these as either “new-ish advances” such as microbicides and PrEP, as well as background biology knowledge regarding vaccines.

It appears that rather than having incorrect information regarding biomedical prevention and clinical trials, respondents are more often just unsure of the information.   We can see this trend by examining the percent of respondents who selected “don’t know,” (which is scored as “incorrect” for the sake of the other analyses).  Here we are seeing more certainty in the questions that respondents correctly answered, however, there are very high percentages of “don’t know” as one looks down the table.  This may be a positive finding for capacity building purposes in that rather than having to re-teach incorrect information, many people are looking for baseline information on some of these new advances, specifically.

Overall, we are pleased at the results of this survey!  In general, it seems that respondents acknowledge that they don’t know or are unsure about certain developments in the field, rather than having misinformation. This is an asset to build on! People are thirsty for information. Also, we are seeing that relatively new information, as well as the biology behind some of these interventions, is less understood at this time.  This is a crucial time for us to create a solid knowledge foundation so that 1) community members know their options and combine the best tools for their lives and 2) the health workforce has accurate information to provide accurate counseling to clients and community members.

Like all new innovations (think about the first time you used Facebook!), it takes some time for folks to know why this is better than (or complements) what we used before (phones, for instance). It takes time, practice and information to know how to use it, when to use it, and with whom to use it.  So keep your phone, keep your condoms and learn about something new.

Written by: Emily Klukas


Note that there were 133 survey included in the analysis.

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