AIDS and Behavior

, Volume 21, Issue 1, pp 300–306 | Cite as

The “Safe Sex” Conundrum: Anticipated Stigma From Sexual Partners as a Barrier to PrEP Use Among Substance Using MSM Engaging in Transactional Sex

  • Katie B. Biello
  • Catherine E. Oldenburg
  • Jennifer A. Mitty
  • Elizabeth F. Closson
  • Kenneth H. Mayer
  • Steven A. Safren
  • Matthew J. Mimiaga
Original Paper


Pre-exposure prophylaxis (PrEP) is efficacious for HIV prevention when taken consistently; however, barriers to PrEP use are poorly understood among individuals who could benefit from PrEP, including men who have sex with men (MSM) who engage in transactional sex (i.e., sex exchanged for money or drugs). Two hundred and thirty-seven HIV-uninfected, PrEP-naive MSM reporting concurrent substance dependence and sexual risk completed a questionnaire on PrEP use barriers. Barriers to PrEP use for MSM who engaged in recent transactional sex (22 %) versus those who had not were compared using an ecological framework. Individual (e.g., HIV stigma, substance use) and structural (e.g., economic, healthcare) barriers did not differ (p > 0.05). MSM who recently engaged in transactional sex were more likely to report that anticipated stigma from primary and casual partners would be barriers to PrEP use. Assessing recent transactional sex may help identify men who may need additional counseling to avoid anticipated stigma so they can integrate PrEP into their lives.


Men who have sex with men HIV Pre-exposure prophylaxis Prevention 


Profilaxis prexposición (PrEP) es un método eficaz para la prevención del VIH cuando se toma los medicamentos de manera constante; sin embargo, las barreras para el uso de PrEP son poco comprendidas entre las personas que podrían beneficiarse de PrEP, incluso los hombres que tienen sexo con hombres (HSH) que participan en sexo transaccional (sexo intercambiado por dinero o drogas). Doscientos treinta y siete HSH VIH-negativo, sin tratamiento PrEP previo, y que han experimentado concurrentemente la dependencia de sustancias y actividades sexuales de riesgo, completaron una encuesta sobre las barreras del uso de PrEP. Se utilizó un modelo ecológico para comparar las barreras para el uso de PrEP entre HSH que han participado en sexo transaccional recientemente (22 %) frente a los que no. Barreras personal (por ejemplo, el estigma del VIH, el abuso de sustancias) y barreras estructurales (por ejemplo, accesibilidad a los servicios de salud, barreras económicas) no difirieron entre los dos grupos (p > 0.05). HSH que participaron recientemente en el sexo transaccional eran lo más probable a informar que el estigma anticipado de las parejas principales y parejas casuales sería una barrera para el uso de PrEP. La evaluación del sexo transaccional reciente podría ayudar a identificar a los hombres que podrían beneficiarse de una orientación adicional para evitar el estigma anticipado para que puedan integrar la PrEP en sus vidas.



The project described was supported by Grant Number R21MH095535 from the National Institute Of Mental Health awarded to Drs. Mimiaga and Mitty. Some author time was funded by K24 MH094214 (SAS) and by Harvard University Center for AIDS Research (CFAR), an NIH funded program (P30 AI060354) (KHM).

Compliance with Ethical Standards

Conflict of Interest

KBB declares that she has no conflict of interest. CEO declares that she has no conflict of interest. JAM declares that she has no conflict of interest. EFC declares that she has no conflict of interest. KHM declares that he has no conflict of interest. SAS declares that he has no conflict of interest. MJM declares that he has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Katie B. Biello
    • 1
    • 2
    • 3
  • Catherine E. Oldenburg
    • 4
  • Jennifer A. Mitty
    • 5
  • Elizabeth F. Closson
    • 3
    • 6
  • Kenneth H. Mayer
    • 3
    • 7
    • 8
  • Steven A. Safren
    • 9
  • Matthew J. Mimiaga
    • 1
    • 2
    • 3
    • 4
  1. 1.Departments of Epidemiology and Behavioral & Social Health SciencesBrown University School of Public HealthProvidenceUSA
  2. 2.Institute for Community Health PromotionBrown UniversityProvidenceUSA
  3. 3.The Fenway InstituteFenway HealthBostonUSA
  4. 4.Department of EpidemiologyHarvard T. H. Chan School of Public HealthBostonUSA
  5. 5.Department of MedicineBeth Israel Deaconess Medical CenterBostonUSA
  6. 6.Department of Social and Environmental Health ResearchThe London School of Hygiene & Tropical MedicineLondonUK
  7. 7.Division of Infectious DiseasesHarvard Medical School/Beth Israel Deaconess Medical CenterBostonUSA
  8. 8.Department of Global Health and PopulationHarvard T. H. Chan School of Public HealthBostonUSA
  9. 9.Department of PsychologyUniversity of MiamiMiamiUSA

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