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Effects of Messaging About Multiple Biomedical and Behavioral HIV Prevention Methods on Intentions to use Among US MSM: Results of an Experimental Messaging Study

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Abstract

Combining multiple biomedical and behavioral HIV prevention approaches is a priority for at-risk populations such as men who have sex with men (MSM), and it is essential to understand how receiving messages about multiple approaches impacts attitudes and intentions for their use. We examined whether receiving combinations of different HIV prevention messages produced differences in perceived benefits and costs of condom use, and in intentions to use condoms and biomedical prevention approaches. MSM (N = 803) were recruited online and were randomly assigned to view informational messages about one, two, or four of the following prevention options: pre-exposure prophylaxis (PrEP), non-occupational post-exposure prophylaxis (nPEP), rectal microbicides, and condoms. The number of HIV prevention messages did not produce differential attitudes and intentions regarding condoms, nor did it produce changes in attitudes towards unprotected sex. Receiving multiple messages was associated with greater intentions to use PrEP and nPEP, but not rectal microbicides.

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Acknowledgments

This work was facilitated by the Center for AIDS Research at Emory University (P30 AI050409).

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Authors and Affiliations

  1. Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave, Suite 2700, Chicago, IL, 60611, USA

    Brian Mustanski, Daniel T. Ryan & Kathryn Macapagal

  2. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Travis Sanchez, Craig Sineath & Patrick S. Sullivan

Authors
  1. Brian Mustanski
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  2. Daniel T. Ryan
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  3. Travis Sanchez
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  4. Craig Sineath
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  5. Kathryn Macapagal
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  6. Patrick S. Sullivan
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Corresponding author

Correspondence to Brian Mustanski.

Appendices

Appendix A: Scripts for HIV prevention messages

Where the script indicates a bullet, the core information from that sentence was shown as text on the screen next to the speaker.

Condoms

Condoms can really reduce your chances of contracting HIV and other sexually transmitted infections, like gonorrhea and chlamydia. Each condom costs about $1 (cost bullet), although there are a lot of places you can get them for free. Condoms work by placing a barrier between two people during sex to prevent exchange of body fluids, like cum, which can transmit infections like HIV and other sexually transmitted infections. To use a condom (how bullet), you just pinch the tip and roll down your or your partner’s penis while it is hard. Be sure that the ring on the condom is on the outside, so it’s easy to roll the condom on. Condoms have been proven to be about 98 % effective (how effective bullet) at preventing the spread of disease when used properly, so be sure to place the condom on correctly, check the expiration date before each use, and use lots of condom-safe lube! There are generally no side effects to using a condom; but, sex with a condom may feel different than sex without a condom (impact on sex bullet) and some people are sensitive to the material it is made from (side effect condom). This has been solved by making condoms from a variety of materials including latex and polyurethane.

Pre-Exposure Prophylaxis (PrEP)

Oral pre-exposure prophylaxis, or PrEP, is a relatively new way of preventing the spread of HIV. Guys taking Truvada, a medication that is normally used to treat HIV, were 44 % less likely to get infected with HIV (how effective bullet). To prevent HIV infection, you would need to take this medication every day, whether you plan to have sex that day or not (how bullet). Skipping a dose would make it less effective. The medication would also have to be prescribed by a doctor who would need to see you at least every 3 months for tests. The cost of Truvada right now is a little less than $1,200 per month (cost bullet). It is possible that the cost may come down a bit if this prevention method becomes more commonly used, and some insurance companies may help cover the cost. However, it is possible that you might have to pay for it yourself. Just like most medications, there are side effects to taking Truvada for extended periods of time. Some people have nausea and fatigue that typically goes away after the first month or so (side effects bullet). In very rare instances there has been liver or kidney damage or a weakening of the bones. Since this involves taking a pill once a day, it doesn’t change what it feels like to have sex (impact on sex bullet).

Non-Occupational Post-Exposure Prophylaxis (nPEP)

nPEP, or non-occupational post-exposure prophylaxis, means taking drugs that are normally used to treat HIV/AIDS after you have had a potential exposure to reduce your likelihood of becoming infected. For instance, if you have unprotected sex with someone who is HIV positive, taking these drugs afterwards can significantly reduce your chance of actually becoming infected with the virus. In order to work properly, the drugs must be taken every day for 28 days after exposure (how bullet), and the pills must be started no later than 3 days after the incident—but the sooner the better! When used properly, has been shown to be an 80 % reduction in transmission (how effective bullet). The drugs cost around $400 to $600 dollars per cycle (cost bullet), and insurance may help cover the cost. Since this prevention method involves taking a pill, there are really no impacts on sexual pleasure (impact on sex bullet). However, some people do experience nausea, fatigue or weight loss while taking the pills (side effects bullet).

Rectal Microbicides

Although they are still being researched and are not currently available to the public, rectal microbicides may be a great way to reduce the transmission of HIV in the future. Only costing about $2 per use (show cost bullet), the microbicides come in a gel form that is squeezed into the rectum using an applicator (how bullet). The gel can even be used like lube, and may even enhance the sexual experience (impact on sex bullet). Microbicide gel contains chemicals that are commonly used to treat HIV in order to kill the virus in your rectum before it has a chance to infect you. Researchers are still working on testing how effective the gels are for rectal use, but they have been shown to reduce the risk of HIV transmission by about 40 % when used vaginally (how effective bullet). It is expected that the rectal use of the microbicides will also be protective against HIV infection. Researchers reformulated the gel made for vaginal use to make it safer for rectal use with very few side effects. Side effects do include possible stomach problems and bruising from improper use of the applicator for the bottom partner (side effects bullet). No side effects were reported for when a penis is exposed to the gel during vaginal use, which means little or no side effects for the top partner.

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Mustanski, B., Ryan, D.T., Sanchez, T. et al. Effects of Messaging About Multiple Biomedical and Behavioral HIV Prevention Methods on Intentions to use Among US MSM: Results of an Experimental Messaging Study. AIDS Behav 18, 1651–1660 (2014). https://doi.org/10.1007/s10461-014-0811-2

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