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Willingness to Take PrEP and Potential for Risk Compensation Among Highly Sexually Active Gay and Bisexual Men

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Abstract

Once-daily Truvada (Emtricitabine/Tenofovir) as a method of pre-exposure prophylaxis (PrEP) is one of the most promising biomedical interventions to eliminate new HIV infections; however, uptake among gay, bisexual, and other men who have sex with men has been slow amidst growing concern in popular/social media that PrEP use will result in reduced condom use (i.e., risk compensation). We investigated demographic, behavioral, and psychosocial differences in willingness to use PrEP as well as the perceived impact of PrEP on participants’ condom use in a sample of 206 highly sexually active HIV-negative gay and bisexual men. Nearly half (46.1 %) said they would be willing to take PrEP if it were provided at no cost. Although men willing to take PrEP (vs. others) reported similar numbers of recent casual male partners (<6 weeks), they had higher odds of recent receptive condomless anal sex (CAS)—i.e., those already at high risk of contracting HIV were more willing to take PrEP. Neither age, race/ethnicity, nor income were associated with willingness to take PrEP, suggesting equal acceptability among subpopulations that are experiencing disparities in HIV incidence. There was limited evidence to suggest men would risk compensate. Only 10 % of men who had not engaged in recent CAS felt that PrEP would result in them starting to have CAS. Men who had not tested for HIV recently were also significantly more likely than others to indicate willingness to take PrEP. Offering PrEP to men who test infrequently may serve to engage them more in routine HIV/STI testing and create a continued dialogue around sexual health between patient and provider in order to prevent HIV infection.

Resumen

Tomar Truvada (Emtricitabine/Tenofovir) una vez al día como un método de Profilaxis Pre- Exposición (PrEP) es una de las intervenciones biomédicas más prometedoras para eliminar nuevas infecciones del VIH; pero igual, el crecimiento del uso de Truvada has sido lento entre hombres que tienen sexo con hombres por la preocupación en medios de comunicación populares/sociales que PrEP resultará en una reducción en el uso de condones. Investigamos diferencias demográficas, de conducta y psicosociales en la disposición para usar PrEP y también el impacto percibido que PrEP podría tener sobre el uso de condones en una muestra de 206 hombres gay y bisexuales que son altamente activos sexualmente. Casi la mitad (46.1 %) dijeron que tomarían PrEP si fuese posible tomarlo sin ningún costo. Aunque los hombres que tienen disposición a tomar PrEP reportaron números similares de parejas sexuales varones y recientes (< 6 semanas), éstos tuvieron más incidentes recientes de sexo sin condón receptivo (SSC)—esto da a entender que los hombres que ya están en alto riesgo de contraer el VIH están más dispuestos a tomar PrEP. Ni la edad, raza/etnicidad, o sueldo personal fueron asociados con ser dispuesto a tomar PrEP, esto sugiere que hay aceptación igual entre subgrupos de población experimentando desigualdades en incidencia del VIH. Hubo evidencia limitada para sugerir que los hombres aumentarían su riesgo porque ya están protegidos por PrEP. Solamente 10% de hombres que no han tenido SSC sintieron que PrEP resultaría en comenzar a tener SSC. Los hombres que no se han realizado la prueba para el VIH recientemente también fueron considerablemente más probables que otros en indicar disposición para tomar PrEP. Ofrecer PrEP a los hombres que se hacen la prueba para el VIH con infrecuencia puede servir en enlazarlos más en la realización de las pruebas de VIH/ETS de manera rutinaria y crear un diálogo continuo sobre la salud sexual entre paciente y proveedor para prevenir la infección con el VIH.

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Acknowledgments

This project was supported by a Research Grant from the National Institute of Mental Health (R01-MH087714; Jeffrey T. Parsons, Principal Investigator). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to acknowledge the contributions of the Pillow Talk Research Team, particularly John Pachankis, Ruben Jimenez, Brian Mustanski, Demetria Cain, and Sitaji Gurung. We would also like to thank CHEST staff who played important roles in the implementation of the project: Chris Hietikko, Joshua Guthals, Chloe Mirzayi, Kailip Boonrai, as well as our team of research assistants, recruiters, and interns. Finally, we thank Chris Ryan, Daniel Nardicio, and Stephan Adel son and the participants who volunteered their time for this study.

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Authors and Affiliations

  1. The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA

    Christian Grov, Thomas H. F. Whitfield, H. Jonathon Rendina, Ana Ventuneac & Jeffrey T. Parsons

  2. Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York (CUNY), Brooklyn, NY, USA

    Christian Grov

  3. CUNY School of Public Health, New York, NY, USA

    Christian Grov & Jeffrey T. Parsons

  4. Department of Psychology, Hunter College of City University of New York (CUNY), 695 Park Ave, New York, NY, 10065, USA

    Jeffrey T. Parsons

  5. Health Psychology and Clinical Science Doctoral Program, The Graduate Center of CUNY, New York, NY, USA

    Thomas H. F. Whitfield & Jeffrey T. Parsons

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  1. Christian Grov
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Correspondence to Jeffrey T. Parsons.

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Grov, C., Whitfield, T.H.F., Rendina, H.J. et al. Willingness to Take PrEP and Potential for Risk Compensation Among Highly Sexually Active Gay and Bisexual Men. AIDS Behav 19, 2234–2244 (2015). https://doi.org/10.1007/s10461-015-1030-1

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