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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

Abstract

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.

Keywords

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

Resumen

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.

Notes

Acknowledgments

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.

References

  1. 1.
    Oldenburg CE, Perez-Brumer AG, Reisner SL, et al. Global burden of HIV among men who engage in transactional sex: a systematic review and meta-analysis. PLoS One. 2014;9(7):e103549.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Oldenburg CE, Perez-Brumer AG, Reisner SL, Mimiaga MJ. Transactional sex and the HIV epidemic among men who have sex with men (MSM): results from a systematic review and meta-analysis. AIDS and Behav. 2015;19(12):2177–83.CrossRefGoogle Scholar
  3. 3.
    Weber AE, Craib KJ, Chan K, et al. Sex trade involvement and rates of human immunodeficiency virus positivity among young gay and bisexual men. Int J Epidemiol. 2001;30(6):1449–54.CrossRefPubMedGoogle Scholar
  4. 4.
    Baral SD, Friedman MR, Geibel S, et al. Male sex workers: practices, contexts, and vulnerabilities for HIV acquisition and transmission. Lancet. 2014;385(9964):260–73.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Oldenburg CE, Perez-Brumer AG, Biello KB, et al. Transactional sex among men who have sex with men in Latin America: economic, sociodemographic, and psychosocial factors. Am J Public Health. 2015;105(5):e95–102.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Baral S, Logie CH, Grosso A, Wirtz AL, Beyrer C. Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health. 2013;13:482.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Baeten JM, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Thigpen MC, Kebaabetswe PM, Paxton LA, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34.CrossRefPubMedGoogle Scholar
  10. 10.
    Van Damme L, Corneli A, Ahmed K, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367(5):411–22.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Grant R MV, Amico R.2013. Drug detection during open-label extension of the iPrEx trial indicates sustained and appropriate interest in PrEP among men who have sex with men. 7th IAS Conference on HIV Pathogenesis Treatment and Prevention.Google Scholar
  12. 12.
    Crosby RA, Geter A, DiClemente RJ, Salazar LF. Acceptability of condoms, circumcision and PrEP among young black men who have sex with men: a descriptive study based on effectiveness and cost. Vaccines (Basel). 2014;2(1):129–37.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDS. 2013;27(4):248–54.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Bauermeister JA, Meanley S, Pingel E, Soler JH, Harper GW. PrEP awareness and perceived barriers among single young men who have sex with men. Curr HIV Res. 2013;11(7):520–7.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Goedel WC, Halkitis PN, Greene RE, Duncan DT.(2016). Correlates of awareness of and willingness to use pre-exposure prophylaxis (PrEP) in gay, bisexual, and Other men who have sex with men who use geosocial-networking smartphone applications in new york city. AIDS Behav.:1–8.Google Scholar
  16. 16.
    Oldenburg CE, Mitty JA, Biello KB, et al. (2015). Differences in attitudes about HIV pre-exposure prophylaxis use among stimulant versus alcohol using men who have sex with men. AIDS and Behav. :1–10.Google Scholar
  17. 17.
    Underhill K, Morrow KM, Colleran C, et al. A qualitative study of medical mistrust, perceived discrimination, and risk behavior disclosure to clinicians by US male sex workers and other men who have sex with men: implications for biomedical HIV prevention. J of Urban Health. 2015;92(2):667–86.CrossRefGoogle Scholar
  18. 18.
    Mimiaga MJ, Closson EF, Kothary V, Mitty JA. Sexual partnerships and considerations for HIV antiretroviral pre-exposure prophylaxis utilization among high-risk substance using men who have sex with men. Arch Sex Behav. 2014;43(1):99–106.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Lecrubier Y, Sheehan D, Weiller E, et al. The mini international neuropsychiatric interview (MINI). a short diagnostic structured interview: reliability and validity according to the CIDI. European psychiatry. 1997;12(5):224–31.CrossRefGoogle Scholar
  20. 20.
    Cohen SE, Vittinghoff E, Bacon O, et al. High interest in preexposure prophylaxis among men who have sex with men at risk for HIV infection: baseline data from the US PrEP demonstration project. J Acquir Immune Defic Syndr. 2015;68(4):439–48.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Liu AY, Cohen SE, Vittinghoff E, et al. Preexposure prophylaxis for HIV infection integrated with municipal- and community-based sexual health services. JAMA Intern Med. 2016;176(1):75–84.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Herron PD. Ethical implications of social stigma associated with the promotion and use of pre-exposure prophylaxis for HIV prevention. LGBT Health. 2016;3(2):103–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Gwadz M, de Guzman R, Freeman R, et al. Exploring how substance use impedes engagement along the HIV Care continuum: a qualitative study. Front Public Health. 2016;4:62.PubMedPubMedCentralGoogle Scholar
  24. 24.
    van Boekel LC, Brouwers EPM, van Weeghel J, Garretsen HFL. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug Alcohol Depen. 2013;131(1–2):23–35.CrossRefGoogle Scholar

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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