Archives of Sexual Behavior

, Volume 43, Issue 1, pp 99–106 | Cite as

Sexual Partnerships and Considerations for HIV Antiretroviral Pre-Exposure Prophylaxis Utilization Among High-Risk Substance Using Men Who Have Sex with Men

  • Matthew J. Mimiaga
  • Elizabeth F. Closson
  • Vishesh Kothary
  • Jennifer A. Mitty
Special Section: Sexual Health in Gay and Bisexual Male Couples


Men who have sex with men (MSM) remain at great risk of HIV in the United States, representing 65 % of incident HIV infections. One factor contributing to the high rate of HIV infection among MSM is use of “recreational” drugs that are highly associated with unprotected anal sex. Pre-exposure chemoprophylaxis (PrEP) is a novel biomedical HIV prevention strategy that has the potential to reduce HIV transmission in MSM. Main and casual sex partners play a role in HIV prevention efforts for MSM. The study aimed to qualitatively explore the perceived influences of sexual relationships on promoting and inhibiting PrEP use among high-risk MSM who report regular drug use. Semi-structured qualitative interviews were conducted with 40 participants recruited in Boston, Massachusetts. Data were analyzed using descriptive qualitative analysis. Casual partners presented a distinct set of concerns from primary partnerships. MSM generally viewed main partners as a potential source of support for taking PrEP. Given their informal and often temporary nature, PrEP disclosure to casual partners was considered unnecessary. HIV-related stigma and substance use were also perceived as barriers to discussing PrEP use with casual partners. MSM articulated a high degree of personal agency regarding their ability to take PrEP. Findings suggest that behavioral interventions to improve PrEP utilization and adherence for high-risk MSM should be tailored to sex partner type and the parameters established between sex partners. Approaches to PrEP disclosure and partner engagement should be informed by the relative benefits and limitations characterized by these different types of relationships.


Men who have sex with men Pre-exposure prophylaxis Sex partners Substance use Sexual orientation 



This project was supported by grant number R21MH085314-01 (MPIs: Mimiaga and Mitty) from the National Institute of Mental Health (NIMH). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIMH or the National Institutes of Health.


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Copyright information

© Springer Science+Business Media New York (outside the USA) 2013

Authors and Affiliations

  • Matthew J. Mimiaga
    • 1
    • 2
    • 3
  • Elizabeth F. Closson
    • 3
  • Vishesh Kothary
    • 3
  • Jennifer A. Mitty
    • 3
    • 4
  1. 1.Behavioral Medicine Service, Department of PsychiatryMassachusetts General HospitalBostonUSA
  2. 2.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  3. 3.The Fenway InstituteFenway HealthBostonUSA
  4. 4.Department of Infectious DiseasesBeth Israel Deaconess Medical Center/Harvard Medical SchoolBostonUSA

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