A significant proportion of new HIV infections among gay, bisexual, and other men who have sex with men (MSM) occur within primary relationships. Although PrEP use continues to increase, there is a need to better understand the factors that contribute to PrEP decision-making within primary relationships. We qualitatively examined how relationship context influences perceptions of PrEP and decisions to initiate and discontinue PrEP among young Black MSM to provide a nuanced understanding of PrEP use within relationships. Between late 2017 and mid-2018, we conducted 10 focus groups with young Black MSM (n = 80) in Milwaukee, WI, Minneapolis, MN, Kansas City, KS, and Detroit, MI. We used inductive thematic analysis to examine how young Black MSM make decisions about PrEP use within the context of primary relationships. We identified three primary themes: (1) perceptions of PrEP as an indication of distrust and infidelity, (2) perceptions of PrEP use as necessary, even in primary relationships, and (3) the influence of partners on PrEP. Our results demonstrate the considerable variation in how young Black MSM view PrEP within primary relationships and the influence of primary partners in PrEP use decisions. The dynamics between two or more individuals can shape an individual’s conceptualizations of and decisions around PrEP use, and these may be key drivers of racial disparities in HIV and PrEP use.
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Funding support was provided by the National Institute of Mental Health (K01-MH112412; PI: Quinn; R01- MH115764; PI: Walsh; P30-MH052776, PI: Jeffrey A. Kelly). The authors would like to acknowledge the support and collaboration of our community partner agencies in Milwaukee, Minneapolis, Kansas City, and Detroit. This work would not be possible without the collaboration and support from community members, leaders, and organizations. Special thanks to all of the staff at the Center for AIDS Intervention Research (CAIR) who were instrumental in this research, especially Kevin Brown, Julia Dickson-Gomez, and Broderick Pearson. We are grateful for the individuals who participated in this research and so graciously and honestly shared their stories with us. Their participation in HIV prevention research is essential to moving the field forward.
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All study procedures were approved by the Institutional Review Board of the Medical College of Wisconsin. All study participants completed a signed informed consent prior to participating in any study procedures.
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Quinn, K.G., Zarwell, M., John, S.A. et al. Perceptions of PrEP Use Within Primary Relationships Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men. Arch Sex Behav 49, 2117–2128 (2020). https://doi.org/10.1007/s10508-020-01683-1
- Pre-exposure prophylaxis (PrEP)
- Black men who have sex with men (MSM)
- HIV prevention
- Sexual orientation