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Perceptions of PrEP Use Within Primary Relationships Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men

Archives of Sexual Behavior volume 49, pages 2117–2128 (2020)Cite this article

Abstract

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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References

  • Biello, K. B., Oldenburg, C. E., Mitty, J. A., Closson, E. F., Mayer, K. H., Safren, S. A., & Mimiaga, M. J. (2017). The “safe sex” conundrum: Anticipated stigma from sexual partners as a barrier to PrEP use among substance using MSM engaging in transactional sex. AIDS and Behavior,21(1), 300–306.

    Article  PubMed  PubMed Central  Google Scholar 

  • Boeije, H. (2002). A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality & Quantity,36, 391–409.

    Article  Google Scholar 

  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology,3(2), 77–101.

    Article  Google Scholar 

  • Brooks, R. A., Kaplan, R. L., Lieber, E., Landovitz, R. J., Lee, S. J., & Leibowitz, A. A. (2011). Motivators, concerns, and barriers to adoption of preexposure prophylaxis for HIV prevention among gay and bisexual men in HIV-serodiscordant male relationships. AIDS Care,23(9), 1136–1145.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brooks, R. A., Landovitz, R. J., Kaplan, R. L., Lieber, E., 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 and STDs,26(2), 87–94.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brown, E. J., Outlaw, F. H., & Simpson, E. M. (2000). Theoretical antecedents to HIV risk perception. Journal of the American Psychiatric Nurses Association,6(6), 177–182.

    Article  Google Scholar 

  • Bush, S., Magnuson, D., Rawlings, M. K., Hawkins, T., McCallister, S., & Giler, R. M. (2016). Racial characteristics of FTC/TDF for pre-exposure prophylaxis (PrEP) users in the US. American Society for Microbiology annual meeting, Oral presentation #2651. http://www.natap.org/2016/HIV/062216_02.htm

  • Corbin, J., & Strauss, A. (2015). Basics of qualitative research: Techniques and procedures for developing grounded theory (4th ed.). Beverly Hills, CA: Sage.

    Google Scholar 

  • Díaz, R. M., & Ayala, G. (1999). Love, passion and rebellion: Ideologies of HIV risk among Latino gay men in the USA. Culture, Health and Sexuality,1(3), 277–293.

    Article  Google Scholar 

  • Finlayson, T., Cha, S., Xia, M., Trujillo, L., Denson, D., Prejean, J., … National HIV Behavioral Surveillance Study Group. (2019). Changes in HIV preexposure prophylaxis awareness and use among men who have sex with men—20 Urban Areas, 2014 and 2017. MMWR. Morbidity and Mortality Weekly Report,68(27), 597–603.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gamarel, K. E., & Golub, S. A. (2014). Intimacy motivations and pre-exposure prophylaxis (PrEP) adoption intentions among HIV-negative men who have sex with men (MSM) in romantic relationships. Annals of Behavioral Medicine,49(2), 177–186.

    Article  Google Scholar 

  • Gamarel, K. E., & Golub, S. A. (2019). Closeness discrepancies and intimacy interference: Motivations for HIV prevention behavior in primary romantic relationships. Personality and Social Psychology Bulletin,45(2), 270–283.

    Article  PubMed  Google Scholar 

  • Goedel, W. C., King, M. R. F., Lurie, M. N., Nunn, A. S., Chan, P. A., & Marshall, B. D. L. (2018). Effect of racial inequities in pre-exposure prophylaxis use on racial disparities in HIV incidence among men who have sex with men: A modeling study. Journal of Acquired Immune Deficiency Syndromes,79(3), 323–329.

    Article  PubMed  Google Scholar 

  • Golub, S. A. (2018). PrEP stigma: Implicit and explicit drivers of disparity. Current HIV/AIDS Reports,15, 190–197.

    Article  PubMed  PubMed Central  Google Scholar 

  • Golub, S. A., Gamarel, K. E., Rendina, H. J., Surace, A., & Lelutiu-Weinberger, C. L. (2013). 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 and STDs,27(4), 248–254.

    Article  PubMed  PubMed Central  Google Scholar 

  • Goodreau, S. M., Carnegie, N. B., Vittinghoff, E., Lama, J. R., Sanchez, J., Grinsztejn, B., … Buchbinder, S. P. (2012). What drives the US and peruvian HIV epidemics in men who have sex with men (MSM)? PLoS ONE,7(11), e50522.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hammack, P. L., Toolis, E. E., Wilson, B. D. M., Clark, R. C., & Frost, D. M. (2019). Making meaning of the impact of pre-exposure prophylaxis (PrEP) on public health and sexual culture: Narratives of three generations of gay and bisexual men. Archives of Sexual Behavior,48(4), 1041–1058.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hojilla, J. C., Koester, K. A., Cohen, S. E., Buchbinder, S., Ladzekpo, D., Matheson, T., & Liu, A. Y. (2016). Sexual behavior, risk compensation, and HIV prevention strategies among participants in the San Francisco PrEP Demonstration Project: A qualitative analysis of counseling notes. AIDS and Behavior,20(7), 1461–1469.

    Article  PubMed Central  Google Scholar 

  • Holt, M., Lea, T., Bear, B., Halliday, D., Ellard, J., Murphy, D., … de Wit, J. (2018). Trends in attitudes to and the use of HIV pre-exposure prophylaxis by Australian gay and bisexual men, 2011–2017: Implications for further implementation from a diffusion of innovations perspective. AIDS and Behavior,23(7), 1939–1950.

    Article  Google Scholar 

  • Jenness, S. M., Maloney, K. M., Smith, D. K., Hoover, K. W., Goodreau, S. M., Rosenberg, E. S., … Sullivan, P. S. (2018). The PrEP care continuum and racial disparities in HIV incidence among men who have sex with men. BioRxiv, 1–18.

  • John, S. A., Robles, G., Starks, T. J., & Rendina, H. J. (2019). Differences between groups of pre-exposure prophylaxis (PrEP) using couples in HIV-negative/unknown relationships. Journal of Acquired Immune Deficiency Syndromes,81(4), 419–428.

    Article  PubMed  Google Scholar 

  • Kanny, D., Jeffries, W., Chapin-Bardales, J., Denning, P., Cha, S., Finlayson, T., Wejnert, C., & National HIV Behavioral Surveillance Study Group. (2019). Racial/ethnic disparities in HIV preexposure prophylaxis among men who have sex with men—23 Urban Areas, 2017. MMWR Morbidity and Mortality Weekly Report, 68, 801–806.

  • Krakower, D., Maloney, K. M., Powell, V. E., Levine, K., Grasso, C., Melbourne, K., … Mayer, K. H. (2019). Patterns and clinical consequences of discontinuing HIV preexposure prophylaxis during primary care. Journal of the International AIDS Society,22(2), e25250. https://doi.org/10.1002/jia2.25250.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lankowski, A. J., Bien-Gund, C. H., Patel, V. V., Felsen, U. R., Silvera, R., & Blackstock, O. J. (2019). PrEP in the real world: Predictors of 6-month retention in a diverse urban cohort. AIDS and Behavior, 23, 1797–1802. https://doi.org/10.1007/s10461-018-2296-x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mabire, X., Puppo, C., Morel, S., Mora, M., Rojas Castro, D., Chas, J., … Préau, M. (2019). Pleasure and PrEP: Pleasure-seeking plays a role in prevention choices and could lead to PrEP initiation. American Journal of Men’s Health, 13(1). https://doi.org/10.1177/1557988319827396.

    Article  PubMed  PubMed Central  Google Scholar 

  • Maulsby, C., Millett, G., Lindsey, K., Kelley, R., Johnson, K., Montoya, D., & Holtgrave, D. (2014). HIV among black men who have sex with men (MSM) in the United States: A review of the literature. AIDS and Behavior,18(1), 10–25.

    Article  PubMed  Google Scholar 

  • McCree, D. H., Williams, A. M., Chesson, H. W., Beer, L., Jeffries, W. L., Lemons, A., … McCray, E. (2019). Changes in disparities in estimated HIV incidence rates among Black, Hispanic/Latino, and White men who have sex with men (MSM) in the United States, 2010–2015. Journal of Acquired Immune Deficiency Syndromes,81(1), 57–62.

    Article  PubMed  Google Scholar 

  • Newcomb, M. E., & Mustanski, B. (2013). Racial differences in same-race partnering and the effects of sexual partnership characteristics on HIV risk in MSM: A prospective sexual diary study. Journal of Acquired Immune Deficiency Syndromes,62(3), 329–333.

    Article  PubMed  Google Scholar 

  • Newman, P. A., Guta, A., Lacombe-Duncan, A., & Tepjan, S. (2018). Clinical exigencies, psychosocial realities: Negotiating HIV pre-exposure prophylaxis beyond the cascade among gay, bisexual and other men who have sex with men in Canada. Journal of the International AIDS Society,21(11), e25211. https://doi.org/10.1002/jia2.25211.

    Article  PubMed  PubMed Central  Google Scholar 

  • Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Beverly Hills: Sage Publications.

    Google Scholar 

  • Quinn, K., Bowleg, L., & Dickson-Gomez, J. (2019). “The fear of being Black plus the fear of being gay”: The effects of intersectional stigma on PrEP use among young Black gay, bisexual, and other men who have sex with men. Social Science and Medicine,232, 86–93.

    Article  PubMed  Google Scholar 

  • Quinn, K. G., Christenson, E., Sawkin, M. T., Hacker, E., & Walsh, J. L. (2019). The unanticipated benefits of PrEP for young Black gay, bisexual, and other men who have sex with men. AIDS and Behavior. https://doi.org/10.1007/s10461-019-02747-7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Quinn, K., & Dickson-Gomez, J. (2016). Homonegativity, religiosity, and the intersecting identities of young black men who have sex with men. AIDS and Behavior,22(1), 51–64.

    Article  Google Scholar 

  • Quinn, K. G., Dickson-Gomez, J., Zarwell, M., Pearson, B., & Lewis, M. (2019). “A gay man and a doctor are just like, a recipe for destruction”: How racism and homonegativity in healthcare settings influence PrEP uptake among young Black MSM. AIDS and Behavior,23(7), 1951–1963. https://doi.org/10.1007/s10461-018-2375-z.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rhodes, T., & Cusick, L. (2000). Love and intimacy in relationship risk management: HIV positive people and their sexual partners. Sociology of Health & Illness,22(1), 1–26.

    Article  Google Scholar 

  • Saldana, J. (2016). The coding manual for qualitative researcher. Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  • Starks, T. J., Doyle, K. M., Shalhav, O., John, S. A., & Parsons, J. T. (2019). An examination of gay couples’ motivations to use (or forego) pre-exposure prophylaxis expressed during couples HIV testing and counseling (CHTC) sessions. Prevention Science,20(15), 157–167.

    Article  PubMed  PubMed Central  Google Scholar 

  • Starks, T. J., Payton, G., Golub, S. A., Weinberger, C. L., & Parsons, J. T. (2014). Contextualizing condom use: Intimacy Interference, stigma, and unprotected sex. Journal of Health Psychology,19(6), 711–720.

    Article  PubMed  Google Scholar 

  • Stephenson, R., White, D., Darbes, L., Hoff, C., & Sullivan, P. (2015). HIV testing behaviors and perceptions of risk of HIV infection among MSM with main partners. AIDS and Behavior,19(3), 553–560.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sullivan, P. S., Hamouda, O., Delpech, V., Geduld, J. E., Prejean, J., Semaille, C., … Fenton, K. A. (2009a). Reemergence of the HIV epidemic among men who have sex with men in North America, Western Europe, and Australia, 1996–2005. Annals of Epidemiology,19(6), 423–431.

    Article  PubMed  Google Scholar 

  • Sullivan, P. S., Peterson, J., Rosenberg, E. S., Kelley, C. F., Cooper, H., Vaughan, A., … DiClemente, R. (2014). Understanding racial HIV/STI disparities in black and white men who have sex with men: A multilevel approach. PLoS ONE,9(3), e90514. https://doi.org/10.1371/journal.pone.0090514.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sullivan, P. S., Salazar, L., Buchbinder, S., & Sanchez, T. H. (2009b). Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS,23(9), 1153–1162. https://doi.org/10.1097/QAD.0b013e32832baa34.

    Article  PubMed  Google Scholar 

  • Theall, K. P., Elifson, K. W., Sterk, C. E., & Klein, H. (2003). Perceived susceptibility to HIV among women. Research on Aging,25(4), 405–432.

    Article  Google Scholar 

  • Wagner, G. J., Bogart, L. M., Klein, D. J., Green, H. D., Mutchler, M. G., McDavitt, B., & Hilliard, C. (2016). Association of internalized and social network level HIV stigma with high-risk condomless sex among HIV-positive African American men. Archives of Sexual Behavior,45(6), 1347–1355.

    Article  PubMed  Google Scholar 

  • Ware, N. C., Wyatt, M. A., Haberer, J. E., Baeten, J. M., Kintu, A., Psaros, C., … Bangsberg, D. R. (2012). What’s love got to do with it? Explaining adherence to oral antiretroviral pre-exposure prophylaxis for HIV-serodiscordant couples. Journal of Acquired Immune Deficiency Syndromes,59(5), 463–468.

    Article  PubMed  Google Scholar 

  • Whitfield, T. H. F., John, S. A., Rendina, H. J., Grov, C., & Parsons, J. T. (2018). Why I quit pre-exposure prophylaxis (PrEP)? A mixed-method study exploring reasons for PrEP discontinuation and potential re-initiation among gay and bisexual men. AIDS and Behavior,22(11), 3566–3575.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zarwell, M., & Robinson, W. T. (2019). Network properties among gay, bisexual, and other men who have sex with men vary by race. AIDS and Behavior,23(5), 1315–1325.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

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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Authors and Affiliations

  1. Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA

    Katherine G. Quinn, Steven A. John, Erika Christenson & Jennifer L. Walsh

  2. Department of Public Health Sciences, University of North Carolina, Charlotte, Charlotte, NC, USA

    Meagan Zarwell

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  1. Katherine G. Quinn
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  2. Meagan Zarwell
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  3. Steven A. John
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  4. Erika Christenson
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Correspondence to Katherine G. Quinn.

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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

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  • DOI: https://doi.org/10.1007/s10508-020-01683-1

Keywords

  • Pre-exposure prophylaxis (PrEP)
  • Black men who have sex with men (MSM)
  • HIV prevention
  • Sexual orientation