Archives of Sexual Behavior

, Volume 47, Issue 7, pp 2123–2133 | Cite as

Are Anal Sex Roles Associated with Preferences for Pre-Exposure Prophylaxis Administration Modalities Among Men Who Have Sex with Men?

  • William C. GoedelEmail author
  • John A. Schneider
  • H. Rhodes Hambrick
  • Noah T. Kreski
  • Jace G. Morganstein
  • Su Hyun Park
  • Ofole Mgbako
  • Dustin T. Duncan
Original Paper


The current study sought to examine awareness of, willingness to use, and preferences for available and theoretical administration modalities for HIV pre-exposure prophylaxis (PrEP) and the association of anal sex roles with these concepts among a sample of men who have sex with men (MSM) in Paris, France. Broadcast advertisements were placed on a popular geosocial-networking smartphone application for MSM to direct users to complete a Web-based survey. MSM answered questions on their recent engagement in condomless anal intercourse and awareness of and willingness to use PrEP in the form of once daily and event-driven pill regimens, long-acting injections, and penile and rectal microbicides as well as sexual roles. Multinomial regression models were fit to assess the association between behaviorally classified anal sexual role and preferences for one of these biomedical prevention modalities. A total of 482 HIV-uninfected MSM completed the survey, 48.1% of whom engaged in some form of condomless anal intercourse in the preceding 3 months. Most respondents (85.3%) had heard of once daily PrEP, but fewer respondents had heard of other prevention strategies. Assuming equal effectiveness, long-acting injections were the most commonly preferred (21.8%). Behaviorally defined “bottom” and “versatile” MSM more frequently preferred long-acting injections (32.9% of “bottoms” and 25.3% of “versatiles”). The development of long-acting injections to deliver antiretroviral drugs and topical microbicides may offer more convenient and acceptable options for HIV prevention among MSM, as MSM in this sample were willing to use them and would prefer to use them over currently available pill regimens.


Men who have sex with men Pre-exposure prophylaxis Gay men’s health Sexual orientation 



Dr. Dustin Duncan is funded in part by National Institutes of Health Grants 1R01MH112405-01, 1R21MH110190-01, and 1R03DA09748-01A1 and the Centers for Disease Control and Prevention grant 1U01PS005122-01. This work was supported by Dr. Dustin Duncan’s New York University School of Medicine Start-Up Research Fund.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest.

Ethnical 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 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individuals included in the study.


  1. Beyrer, C., Baral, S. D., Van Griensven, F., Goodreau, S. M., Chariyalertsak, S., Wirtz, A. L., & Brookmeyer, R. (2012). Global epidemiology of HIV infection in men who have sex with men. Lancet, 380(9839), 367–377. doi: 10.1016/S0140-6736(12)60821-6.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Brooks, R. A., Landovitz, R. J., Kaplan, R. L., Lee, S. J., & Barkley, T. W. (2012). Sexual risk behaviors and acceptability of HIV pre-exposure prophylaxis among HIV-negative gay and bisexual men in serodiscordant relationships: A mixed methods study. AIDS Patient Care & STDs, 26(2), 87–94. doi: 10.1089/apc.2011.0283.CrossRefGoogle Scholar
  3. Calabrese, S. K., & Underhill, K. (2015). How stigma surrounding the use of HIV preexposure prophylaxis undermines prevention and pleasure: A call to destigmatize “Truvada whores”. American Journal of Public Health, 105(10), 1960–1964. doi: 10.2105/ajph.2015.302816.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Dangerfield, D. T. II., Smith, L. R., Williams, J., Unger, J., & Bluthenthal, R. (2017). Sexual positioning among men who have sex with men: A narrative review. Archives of Sexual Behavior, 46, 869–884.CrossRefPubMedGoogle Scholar
  5. Eaton, L. A., Driffin, D. D., Bauermeister, J., Smith, H., & Conway-Washington, C. (2015). Minimal awareness and stalled uptake of pre-exposure prophylaxis (PrEP) among at-risk, HIV-negative, Black men who have sex with men. AIDS and Behavior, 29(8), 423–429. doi: 10.1089/apc.2014.0303.Google Scholar
  6. European Centre for Disease Prevention and Control. (2015). Men who have sex with men: Monitoring implementation of the Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia: 2014 progress report. Stockholm: Author.Google Scholar
  7. European Centre for Disease Prevention and Control. (2016). HIV/AIDS surveillance in Europe, 2015. Stockholm: Author.Google Scholar
  8. Ferrer, L., Folch, C., Fernandez-Davila, P., Garcia, A., Morales, A., Belda, J., … Casabona, J. (2016). Awareness of pre-exposure prophylaxis for HIV, willingness to use it and potential barriers or facilitators to uptake among men who have sex with men in Spain. AIDS and Behavior, 20(7), 1423–1433. doi: 10.1007/s10461-016-1379-9.CrossRefPubMedGoogle Scholar
  9. French, R. S., Bonell, C., Weillings, K., & Weatherburn, P. (2014). An exploratory review of HIV prevention mass media campaigns targeting men who have sex with men. BMC Public Health, 14(1), 616. doi: 10.1186/1471-2458-14-616.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Gil, S. (2007). A narrative exploration of gay men’s sexual practices as a dialectical dialogue. Sexual and Relationship Therapy, 22(1), 63–75. doi: 10.1080/14681990600861057.CrossRefGoogle Scholar
  11. Goedel, W. C., Halkits, P. N., Greene, R. E., & Duncan, D. T. (2016a). 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 and Behavior, 20(7), 1435–1442. doi: 10.1007/s10461-016-1353-6.CrossRefPubMedGoogle Scholar
  12. Goedel, W. C., Halkits, P. N., Greene, R. E., Hickson, D. A., & Duncan, D. T. (2016b). HIV risk behaviors, perceptions, and testing and preexposure prophylaxis (PrEP) awareness/use in Grindr-using men who have sex with men in Atlanta, Georgia. Journal of the Association of Nurses in AIDS Care, 27(2), 133–142. doi: 10.1016/j.jana.2015.11.005.CrossRefPubMedGoogle Scholar
  13. Gomez, G. B., Borquez, A., Case, K. K., Wheelock, A., Vassall, A., & Hankins, C. (2013). The cost and impact of scaling up pre-exposure prophylaxis for HIV prevention: A systematic review of cost-effectiveness modelling studies. PLoS Medicine, 10(3), e1001401. doi: 10.1371/journal.pmed.1001401.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Grant, R. M., Anderson, P. L., McMahan, V., Liu, A., Amico, K. R., Mehrotra, M., … iPrEx Study Team. (2014). Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: A cohort study. Lancet Infectious Diseases, 14(9), 820–829. doi: 10.1016/S1473-3099(14)70847-3.CrossRefPubMedGoogle Scholar
  15. Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., … iPrEx Study Team. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 2010(363), 2587–2599. doi: 10.1056/NEJMoa1011205.CrossRefGoogle Scholar
  16. Grov, C., Rendina, H. J., Whitfield, T. H., Ventuneac, A., & Parsons, J. T. (2016). Changes in familiarity with and willingness to take preexposure prophylaxis in a longitudinal study of highly sexually active gay and bisexual men. LGBT Health, 3(4), 252–257. doi: 10.1089/lgbt.2015.0123.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Grov, C., Whitfield, T. H. F., Rendina, H. J., Ventuneac, A., & Parsons, J. T. (2015). Willingness to take PrEP and potential for risk compensation among highly sexually active gay and bisexual men. AIDS and Behavior, 19(12), 2234–2244. doi: 10.1007/s10461-015-1030-1.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Hall, E. W., Heneine, W., Sanchez, T., Sineath, R. C., & Sullivan, P. S. (2016). Preexposure prophylaxis modality preferences among men who have sex with men and use social media in the United States. Journal of Medical Internet Research, 18(5), e111. doi: 10.2196/jmir.5713.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Harkness, J. (2005). SHARE translation procedures and translation assessment. In A. Börsch-Supan & H. Jürges (Eds.), The survey of health, aging, and retirement in Europe—Methodology (pp. 24–27). Mannheim: Mannheim Research Institute for the Economics of Aging.Google Scholar
  20. Hemmige, V., Snyder, H., Liao, C., Mayer, K., Lakshmi, V., Gandham, S. R., … Schneider, J. (2011). Sex position, marital status, and HIV risk among Indian men who have sex with men: Clues to optimizing prevention approaches. AIDS Patient Care & STDs, 25(12), 725–734. doi: 10.1089/apc.2011.0079.CrossRefGoogle Scholar
  21. Holt, M., Murphy, D. A., Callander, D., Ellard, J., Rosengarten, M., Kippax, S. C., & De Wit, J. B. (2012). Willingness to use HIV pre-exposure prophylaxis and the likelihood of decreased condom use are both associated with unprotected anal intercourse and the perceived likelihood of becoming HIV-positive among Australian gay and bisexual men. Sexually Transmitted Infections, 88(4), 258–263. doi: 10.1136/sextrans-2011-050312.CrossRefPubMedGoogle Scholar
  22. John, S. A., Starks, T. J., Rendina, H. J., Grov, C., & Parsons, J. T. (2017). Should I convince my partner to go on pre-exposure prophylaxis (PrEP)? The role of personal and relationship factors on PrEP-related social control among gay and bisexual men. AIDS and Behavior. doi: 10.1007/s10461-017-1835-1.Google Scholar
  23. Johns, M. M., Pingel, E., Eisenberg, A., Santana, M. L., & Bauermeister, J. (2012). Butch tops and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men. American Journal of Men’s Health, 6(6), 505–518. doi: 10.1177/1557988312455214.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Kapur, A., Schneider, J. A., Heard, D., Mukherjee, S., Schumm, P., Oruganti, G., & Laumann, E. O. (2014). A digital network approach to infer sex behavior in emerging HIV epidemics. PLoS ONE, 9(7), e101416. doi: 10.1371/journal.pone.0101416.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Kilmarx, P. H., & Mutasa-Apollo, T. (2013). Patching a leaky pipe: The cascade of HIV care. Current Opinions in HIV/AIDS, 8(1), 59–64. doi: 10.1097/COH.0b013e32835b806e.Google Scholar
  26. Kippax, S. C., & Smith, G. (2001). Anal intercourse and power in sex between men. Sexualities, 4(4), 413–434. doi: 10.1177/136346001004004002.CrossRefGoogle Scholar
  27. Landovitz, R. J., Kofron, R., & McCauley, M. (2016). The promise and pitfalls of long-acting injectable agents for HIV prevention. Current Opinions in HIV/AIDS, 11(1), 122–128. doi: 10.1097/COH.0000000000000219.Google Scholar
  28. Liu, A., Cohen, S., Follansbee, S., Cohan, D., Weber, S., Sachdev, D., & Buchbinder, S. (2014). Early experiences implementing pre-exposure prophylaxis (PrEP) for HIV prevention in San Francisco. PLoS Medicine, 11(3), e1001613. doi: 10.1371/journal.pmed.1001613.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Lorente, N., Fugon, L., Carrieri, M. P., Andreo, C., Le Gall, J.-M., Cook, E., … Spire, B. (2012). Acceptability of an “on-demand” pre-exposure HIV prophylaxis trial among men who have sex with men living in France. AIDS Care, 24(4), 468–477. doi: 10.1080/09540121.2011.626394.CrossRefPubMedGoogle Scholar
  30. Mansergh, G., Koblin, B. A., & Sullivan, P. S. (2012). Challenges for HIV pre-exposure prophylaxis among men who have sex with men in the United States. PLoS Medicine, 9(8), e1001286. doi: 10.1371/journal.pmed.1001286.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Marcus, U., Hickson, F., Weatherburn, P., & Schmidt, A. J. (2013). Estimating the size of the MSM populations for 38 European countries by calculating the survey-surveillance discrepancies (SSD) between self-reported new HIV diagnoses from the European MSM internet survey (EMIS) and surveillance-reported HIV diagnoses among MSM in 2009. BMC Public Health, 13(1), 919. doi: 10.1186/1471-2458-13-919.CrossRefPubMedPubMedCentralGoogle Scholar
  32. Marra, E., & Hankins, C. A. (2015). Perceptions among Dutch men who have sex with men and their willingness to use rectal microbicides and oral pre-exposure prophylaxis to reduce HIV risk—A preliminary study. AIDS Care, 27(12), 1493–1500. doi: 10.1080/09540121.2015.1069785.CrossRefPubMedGoogle Scholar
  33. McCormack, S., Dunn, D. T., Desai, M., Dolling, D. I., Gafos, M., Gilson, R., … Schembri, G. (2016). Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): Effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet, 387(10013), 53–60. doi: 10.1016/S0140-6736(15)00056-2.CrossRefPubMedPubMedCentralGoogle Scholar
  34. McGowan, I. (2014). The development of rectal microbicides for HIV prevention. Expert Opinions in Drug Delivery, 11(1), 69–82. doi: 10.1517/17425247.2013.860132.CrossRefGoogle Scholar
  35. McGowan, I. (2015). Injectable and implantable antiretroviral strategies for HIV prevention. Future Virology, 10(10), 1163–1176. doi: 10.2217/fvl.15.83.CrossRefGoogle Scholar
  36. Molina, J.-M. (2016). PrEP roll-out in France. Paper presented at the World AIDS Conference, Durban, South Africa.Google Scholar
  37. Molina, J. M., Capitant, C., Spire, B., Pialoux, G., Cotte, L., Charreau, I., … ANRS IPERGAY Study Group. (2015). On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. New England Journal of Medicine, 373(23), 2237–2246. doi: 10.1056/NEJMoa1506273.CrossRefPubMedGoogle Scholar
  38. Moskowitz, D. A., & Hart, T. A. (2011). The influence of physical body traits and masculinity on anal sex roles in gay and bisexual men. Archives of Sexual Behavior, 40(4), 835–841. doi: 10.1007/s10508-011-9754-0.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Moskowitz, D. A., Rieger, G., & Roloff, M. E. (2008). Tops, bottoms, and versatiles. Sexual and Relationship Therapy, 23(3), 191–202. doi: 10.1080/14681990802027259.CrossRefGoogle Scholar
  40. Okwundu, C. I., & Okoromah, C. A. (2012). Antiretroviral pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals. Cochrane Database of Systematic Reviews, 11(7), CD007189. doi: 10.1002/14651858.CD007189.pub3.Google Scholar
  41. Parsons, J. T., Rendina, H. J., Whitfield, T. H., & Grov, C. (2016). Familiarity with and preferences for oral and long-acting injectable HIV pre-exposure prophylaxis (PrEP) in a national sample of gay and bisexual men in the US. AIDS and Behavior, 20(7), 1390–1399. doi: 10.1007/s10461-016-1370-5.CrossRefPubMedPubMedCentralGoogle Scholar
  42. Parsons, J. T., Schrimshaw, E. W., Wolitski, R. J., Halkits, P. N., Purcell, D. W., Hoff, C. C., & Gomez, C. A. (2005). Sexual harm reduction practices of HIV-seropositive gay and bisexual men: Serosorting, strategic positioning, and withdrawal before ejaculation. AIDS and Behavior, 19(S1), S13–S25. doi: 10.1097/01.aids.0000167348.15750.9a.CrossRefGoogle Scholar
  43. Rendina, H. J., Whitfield, T. H., Grov, C., Starks, T. J., & Parsons, J. T. (2017). Distinguishing hypothetical willingness from behavioral intentions to initiate HIV pre-exposure prophylaxis (PrEP): Findings from a large cohort of gay and bisexual men in the US. Social Science and Medicine. doi: 10.1016/j.socscimed.2016.10.030.PubMedGoogle Scholar
  44. Varghese, B., Maher, J. E., Peterman, T. A., Branson, B. M., & Steketee, R. W. (2002). Reducing the risk of sexual HIV transmission: Quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use. Sexually Transmitted Diseases, 29(1), 38–43. doi: 10.1097/00007435-200201000-00007.CrossRefPubMedGoogle Scholar
  45. Volk, J. E., Liu, A., Vittinghoff, E., Irvin, R., Kroboth, E., Krakower, D., … Buchbinder, S. (2012). Sexual frequency and planning among at-risk men who have sex with men (MSM) in the US: Implications for event-based intermittent pre-exposure prophylaxis (iPrEP). Journal of Acquired Immune Deficiency Syndromes, 61(1), 112. doi: 10.1097/qai.0b013e31825bd87d.CrossRefPubMedGoogle Scholar
  46. Wegesin, D. J., & Meyer-Bahlburg, H. F. L. (2000). Top/bottom self-label, anal sex practices, HIV risk and gender role identity in gay men in New York City. Journal of Psychology & Human Sexuality, 12(3), 43–62. doi: 10.1300/j056v12n03_03.CrossRefGoogle Scholar
  47. Wei, C., & Raymond, H. F. (2011). Preference for and maintenance of anal sex roles among men who have sex with men: Sociodemographic and behavioral correlates. Archives of Sexual Behavior, 40(4), 829–834. doi: 10.1007/s10508-010-9623-2.CrossRefPubMedGoogle Scholar
  48. Zhang, H., Lu, H., Pan, S. W., Xia, D., Zhao, Y., Xiao, Y., … Shao, Y. (2015). Correlates of unprotected anal intercourse: The influence of anal sex position among men who have sex with men in Beijing, China. Archives of Sexual Behavior, 44, 375–387.Google Scholar
  49. Zhou, C., Raymond, H. F., Ding, X., Lu, R., Xu, J., Wu, G., … Shao, Y. (2013). Anal sex role, circumcision status, and HIV infection among men who have sex with men in Chongqing, China. Archives of Sexual Behavior, 42, 1275–1283.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • William C. Goedel
    • 1
    Email author
  • John A. Schneider
    • 2
    • 3
  • H. Rhodes Hambrick
    • 1
  • Noah T. Kreski
    • 1
  • Jace G. Morganstein
    • 1
  • Su Hyun Park
    • 1
  • Ofole Mgbako
    • 1
    • 4
  • Dustin T. Duncan
    • 1
  1. 1.Department of Population Health, Spatial Epidemiology LabNew York University School of MedicineNew YorkUSA
  2. 2.Department of MedicineUniversity of ChicagoChicagoUSA
  3. 3.Department of Public Health SciencesUniversity of ChicagoChicagoUSA
  4. 4.Department of Internal MedicineNew York University School of MedicineNew YorkUSA

Personalised recommendations