Ambiguity, Ambivalence, and Apprehensions of Taking HIV-1 Pre-Exposure Prophylaxis among Male Couples in San Francisco: A Mixed Methods Study

Abstract

ObjectiveWe conducted a mixed-methods study to examine serodiscordant and seroconcordant (HIV-positive/HIV-positive) male couples' PrEP awareness, concerns regarding health care providers offering PrEP to the community, and correlates of PrEP uptake by the HIV-negative member of the couple.DesignQualitative sub-study included one-on-one interviews to gain a deeper understanding of participants' awareness of and experiences with PrEP and concerns regarding health care providers offering PrEP to men who have sex with men (MSM). Quantitative analyses consisted of a cross-sectional study in which participants were asked about the likelihood of PrEP uptake by the HIV-negative member of the couple and level of agreement with health care providers offering PrEP to anyone requesting it.MethodsWe used multivariable regression to examine associations between PrEP questions and covariates of interest and employed an inductive approach to identify key qualitative themes.ResultsAmong 328 men (164 couples), 62% had heard about PrEP, but approximately one-quarter were mistaking it with post-exposure prophylaxis. The majority of participants had low endorsement of PrEP uptake and 40% were uncertain if health care providers should offer PrEP to anyone requesting it. Qualitative interviews with 32 men suggest that this uncertainty likely stems from concerns regarding increased risk compensation. Likelihood of future PrEP uptake by the HIV-negative member of the couple was positively associated with unprotected insertive anal intercourse but negatively correlated with unprotected receptive anal intercourse.ConclusionsFindings suggest that those at greatest risk may not be receptive of PrEP. Those who engage in moderate risk express more interest in PrEP; however, many voice concerns of increased risk behavior in tandem with PrEP use. Results indicate a need for further education of MSM communities and the need to determine appropriate populations in which PrEP can have the highest impact.

HIV-Negative Partnered Men's Willingness to Use Pre-Exposure Prophylaxis and Associated Factors Among an Internet Sample of U.S. HIV-Negative and HIV-Discordant Male Couples

“…In contrast, in a study conducted in San Francisco with concordant HIV-positive and HIV-discordant male couples, Saberi and colleagues (2012) found that the majority of partnered men did not endorse PrEP and some were concerned about the possible increases in risk compensation as a result of PrEP use. 53 Although this study did not collect qualitative data to examine the reasons why partnered men might be more or less willing to use PrEP, these findings provide support for partnered men's willingness to use PrEP, particularly among certain subgroups of gay male couples. However, future research studies that collect data from a more representative sample of male couples would provide a greater understanding of men's willingness to use PrEP.…”

Minimal Awareness and Stalled Uptake of Pre-Exposure Prophylaxis (PrEP) Among at Risk, HIV-Negative, Black Men Who Have Sex with Men

“…18,19 In order to increase uptake of PrEP, it is critical that we focus attention on how PrEP is being embraced by populations at-risk for HIV. Our understanding of community perspectives of PrEP suggests that there are multiple limitations to accessing it, 10,11,[20][21][22][23][24] and that populations in need might not be receiving information about PrEP. 25 We must also acknowledge that those who are at greatest risk for HIV may be least likely to be aware of its availability or have the means to access it.…”

Attitudes Towards PrEP and Anticipated Condom Use Among Concordant HIV-Negative and HIV-Discordant Male Couples

“…However, one that did suggested that behavioral interventions to improve utilization should be targeted to sex-partner type, given that main partners were viewed as a support for taking PrEP but casual partners were associated with barriers to PrEP disclosure. 22 One study of MSM couples found that participants' concerns about risk compensation may decrease their interest in PrEP, 23 and another study found that concerns about intermittent use was considered a barrier to PrEP use. 24 In contrast, higher HIV risk perception, intimacy motivations for condomless sex, recent condomless anal sex with outside partners, education, and age were each independently associated with PrEP adoption intentions.…”