Designing a novel peer-based decision aid to address perceived risk for HIV and PrEP interest among Black sexual minority men

Black gay, bisexual, and other Black sexual minority men (SMM) continue to experience significant Human Immunodificiency Virus (HIV) pre-exposure prophylaxis (PrEP) barriers, including stigma, medical mistrust, and low risk perceptions. Peer change agents (PCAs) are effective interventionists but are costly to scale. Therefore, we designed a culturally responsive web-based decision aid designed to improve perceived risk for HIV (PRH) and PrEP use among Black SMM modelled after a PCA-based intervention called POSSIBLE. The key domains of the PCA script in POSSIBLE were transposed into the online format of the decision aid and included interactive features to simulate peer-based interactions, encourage user reflection, and guide decision-making in a culturally resonant manner. Visual aids were also incorporated to approximate the peer-based approach in POSSIBLE. Content analysis of PCA-participant conversations among 12 participants from POSSIBLE who decided to use PrEP was conducted to identify common concerns among Black SMM and the persuasive language used by the PCA. Those concerns and communications collectively informed the response options and information of the online tool. This prototype offers a scalable, culturally responsive approach to addressing key multilevel PrEP barriers among Black SMM, including stigma, medical mistrust, and PRH. This tool could be a valuable resource in clinical and community-based settings, providing a cost-effective alternative to peer-based interventions. Future research will assess its impact on multilevel barriers, PrEP use, and HIV prevention behaviours in real-world settings.