Skip to main content

Advertisement

SpringerLink
Log in

Temporal Fluctuations in Behavior, Perceived HIV Risk, and Willingness to Use Pre-Exposure Prophylaxis (PrEP)

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Individual perceptions of HIV risk influence willingness to use pre-exposure prophylaxis (PrEP) for HIV prevention. Among men who have sex with men (MSM) and male sex workers (MSWs), temporal or episodic changes in risk behavior may influence perceived risk and PrEP acceptability over time. We investigated fluctuations in perceived HIV risk and PrEP acceptability, comparing MSWs against MSM who do not engage in sex work. We conducted 8 focus groups (n = 38) and 56 individual interviews among MSM and MSWs in Providence, RI. Perceived HIV risk shaped willingness to use PrEP among both MSWs and MSM who did not engage in sex work, and risk perceptions changed over time depending on behavior. For MSWs, perceived risk cycled according to patterns of substance use and sex work activity. These cycles yielded an “access-interest paradox”: an inverse relationship between willingness to use and ability to access PrEP. MSM who did not engage in sex work also reported temporal shifts in risk behavior, perceived risk, and willingness to use PrEP, but changes were unrelated to access. MSM attributed fluctuations to seasonal changes, vacations, partnerships, behavioral “phases,” and episodic alcohol or drug use. Efforts to implement PrEP among MSM and street-based MSWs should address temporal changes in willingness to use PrEP, which are linked to perceived risk. Among MSWs, confronting the access-interest paradox may require intensive outreach during high-risk times and efforts to address low perceived risk during times of reduced sex work.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Alam, S. J., Zhang, X., Romero-Severson, E. O., Henry, C., Zhong, L., Volz, E. M., … Koopman, J. S. (2013). Detectable signals of episodic risk effects on acute HIV transmission: Strategies for analyzing transmission systems using genetic data. Epidemics, 5(1), 44–55.

    Article  PubMed  Google Scholar 

  • Amico, K. R., & Stirratt, M. J. (2014). Adherence to preexposure prophylaxis: Current, emerging, and anticipated bases of evidence. Clinical Infectious Diseases, 59(Suppl. 1), S55–S60.

    Article  PubMed  PubMed Central  Google Scholar 

  • Anderson, P. L., Glidden, D. V., Liu, A., Buchbinder, S., Lama, J. R., Guanira, J. V., … Grant, R. M. (2012). Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Science Translational Medicine, 4(151), 151ra125. https://doi.org/10.1126/scitranslmed.3004006.

    Article  PubMed  PubMed Central  Google Scholar 

  • Associated Press. (2009, 3 November). Rhode Island: New prostitution law. The New York Times, p. A17. Retrieved from http://www.nytimes.com/2009/11/04/us/04brfs-NEWPROSTITUT_BRF.html?_r=0.

  • Baeten, J. M., Donnell, D., Ndase, P., Mugo, N. R., Campbell, J. D., Wangisi, J., … Partners in Prevention HSV/HIV Transmission Study Team. (2012). Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. New England Journal of Medicine, 367(5), 399–410.

    Article  PubMed  Google Scholar 

  • Baral, S. D., Friedman, M. R., Geibel, S., Rebe, K., Bozhinov, B., Diouf, D., … Cáceres, C. F. (2015). Male sex workers: Practices, contexts, and vulnerabilities for HIV acquisition and transmission. Lancet, 385, 260–273.

    Article  PubMed  Google Scholar 

  • Braun, V., & Clarke, V. (2005). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.

    Article  Google Scholar 

  • Carlo Hojilla, J., 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  PubMed Central  Google Scholar 

  • CDC. (2014). Preexposure prophylaxis for the prevention of HIV infection in the United States 2014: A clinical practice guideline. Retrieved from http://www.cdc.gov/hiv/pdf/PrEPguidelines2014.pdf.

  • CDC. (2017). HIV among gay and bisexual men. Retrieved from https://www.cdc.gov/hiv/group/msm/index.html.

  • Chakrapani, V., Newman, P. A., Shunmugam, M., Mengle, S., Varghese, J., Nelson, R., & Bharat, S. (2015). Acceptability of HIV pre-exposure prophylaxis (PrEP) and implementation challenges among men who have sex with men in India: A qualitative investigation. AIDS Patient Care and STDs, 29(10), 569–577.

    Article  PubMed  Google Scholar 

  • Choopanya, K., Martin, M., Suntharasamai, P., Sangkum, U., Mock, P. A., Leethochawalit, M., … Vanichseni, S. (2013). Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): A randomised, double-blind, placebo-controlled phase 3 trial. Lancet, 381(9883), 2083–2090.

    Article  PubMed  Google Scholar 

  • Cohan, D., Lutnick, A., Davidson, P., Cloniger, C., Herlyn, A., Breyer, J., … Klausner, J. (2006). Sex worker health: San Francisco style. Sexually Transmitted Infections, 82(5), 418–422.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cohen, S. E., Vittinghoff, E., Bacon, O., Doblecki-Lewis, S., Postle, B. S., Feaster, D. J., … Liu, A. Y. (2015). 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. Journal of Acquired Immune Deficiency Syndromes, 68(4), 439–448.

    Article  PubMed  Google Scholar 

  • Cremin, I., Morales, F., Jewell, B. L., O’Reilly, K. R., & Hallett, T. B. (2015). Seasonal PrEP for partners of migrant miners in southern Mozambique: A highly focused PrEP intervention. Journal of the International AIDS Society, 18(4 Suppl. 3), 19946. https://doi.org/10.7448/IAS.18.4.19946.

    PubMed  PubMed Central  Google Scholar 

  • Denzin, N. K., & Lincoln, Y. S. (Eds.). (2011). Introduction: The discipline and practice of qualitative research. In The SAGE handbook of qualitative research (pp. 1–20). Thousand Oaks, CA: SAGE Publications Inc.

  • Donnell, D., Baeten, J. M., Bumpus, N. N., Brantley, J., Bangsberg, D. R., Haberer, J. E., … Celum, C. (2014). HIV protective efficacy and correlates of tenofovir blood concentrations in a clinical trial of PrEP for HIV prevention. Journal of Acquired Immune Deficiency Syndromes, 66, 340–348.

    Article  PubMed  Google Scholar 

  • 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 Patient Care and STDs, 29(8), 423–429.

    Article  PubMed  PubMed Central  Google Scholar 

  • Elsesser, S. A., Oldenburg, C. E., Biello, K. B., Mimiaga, M. J., Safren, S. A., Egan, J. E., … Mayer, K. H. (2016). Seasons of Risk: Anticipated behavior on vacation and interest in episodic antiretroviral pre-exposure prophylaxis (PrEP) among a large national sample of U.S. men who have sex with men (MSM). AIDS and Behavior, 20(7), 1400–1407.

    Article  PubMed  PubMed Central  Google Scholar 

  • Escudero, D. J., Kerr, T., Wood, E., Nguyen, P., Lurie, M. N., Sued, O., & Marshall, B. D. (2015). Acceptability of HIV pre-exposure prophylaxis (PREP) among people who inject drugs (PWID) in a Canadian setting. AIDS and Behavior, 19(5), 752–757.

    Article  PubMed  PubMed Central  Google Scholar 

  • Falcao, J., Ahoua, L., Zerbe, A., di Mattei, P., Baggaley, R., Chivurre, V., …, El-Sadr, W. (2017). Willingness to use short-term oral pre-exposure prophylaxis (PrEP) by migrant miners and female partners of migrant miners in Mozambique. Culture, Health & Sexuality, 19, 1389–1403.

  • FDA. (2012). Truvada for PrEP fact sheet: Ensuring safe and proper use. Silver Spring, MD: Food and Drug Administration. https://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM312290.pdf.

  • Gallagher, T., Link, L., Ramos, M., Bottger, E., Aberg, J., & Daskalakis, D. (2014). Self-perception of HIV risk and candidacy for pre-exposure prophylaxis among men who have sex with men testing for HIV at commercial sex venues in New York City. LGBT Health, 1(3), 218–224.

    Article  PubMed  Google Scholar 

  • Geibel, S., King’ola, N., Temmerman, M., & Luchters, S. (2012). The impact of peer outreach on HIV knowledge and prevention behaviours of male sex workers in Mombasa, Kenya. Sexually Transmitted Infections, 88(5), 357–362.

    Article  PubMed  Google Scholar 

  • Gilmore, H. J., Liu, A., Koester, K. A., Amico, K. R., McMahan, V., Goicochea, P., … Grant, R. (2013). Participant experiences and facilitators and barriers to pill use among men who have sex with men in the iPrEx pre-exposure prophylaxis trial in San Francisco. AIDS Patient Care and STDs, 27(10), 560–566.

    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 

  • Grant, R. M., Anderson, P. L., McMahan, V., Liu, A., Amico, K. R., Mehrotra, M., … Glidden, D. V. (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.

    Article  PubMed  Google Scholar 

  • Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., … Glidden, D. V. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363, 2587–2599.

    Article  PubMed  Google Scholar 

  • HIV Prevention Trials Network. (2017). HPTN 067: A phase II, randomized, open-label, pharmacokinetic and behavioral study of the use of intermittent oral emtricitabine/tenofovir disoproxil fumarate pre-exposure prophylaxis (PrEP). Retrieved from https://www.hptn.org/research/studies/hptn067.

  • Holt, M. (2014). HIV pre-exposure prophylaxis and treatment as prevention: A review of awareness and acceptability among men who have sex with men in the Asia-Pacific region and the Americas. Sexual Health, 11(2), 166–170.

    PubMed  Google Scholar 

  • King, H. L., Keller, S. B., Giancola, M. A., Rodriguez, D. A., Chau, J. J., Young, J. A., … Smith, D. M. (2014). Pre-exposure prophylaxis accessibility research and evaluation (PrEPARE Study). AIDS and Behavior, 18(9), 1722–1725.

    Article  PubMed  PubMed Central  Google Scholar 

  • Krakower, D. S., Mimiaga, M. J., Rosenberger, J. G., Novak, D. S., Mitty, J. A., White, J. M., & Mayer, K. H. (2012). Limited awareness and low immediate uptake of pre-exposure prophylaxis among men who have sex with men using an internet social networking site. Public Library of Science ONE, 7(3), e33119. https://doi.org/10.1371/journal.pone.0033119.

    PubMed  Google Scholar 

  • Kurtz, S. P., Buttram, M. E., & Surratt, H. L. (2014). Vulnerable infected populations and street markets for ARVs: Potential implications for PrEP rollout in the USA. AIDS Care, 26(4), 411–415.

    Article  PubMed  Google Scholar 

  • Landers, S., Closson, E. F., Oldenburg, C. E., Holcomb, R., Spurlock, S., & Mimiaga, M. J. (2014). HIV prevention needs among street-based male sex workers in Providence, Rhode Island. American Journal of Public Health, 104(11), e100–e102.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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. Public Library of Science Medicine, 11(3), e1001613. https://doi.org/10.1371/journal.pmed.1001613.

    PubMed  Google Scholar 

  • Liu, A. Y., Vittinghoff, E., Chillag, K., Mayer, K., Thompson, M., Grohskopf, L., … Buchbinder, S. P. (2013). Sexual risk behavior among HIV-uninfected men who have sex with men participating in a tenofovir preexposure prophylaxis randomized trial in the United States. Journal of Acquired Immune Deficiency Syndromes, 64(1), 87–94.

    Article  PubMed  Google Scholar 

  • Marcus, J. L., Glidden, D. V., Mayer, K. H., Liu, A. Y., Buchbinder, S. P., Amico, K. R., … Grant, R. M. (2013). No evidence of sexual risk compensation in the iPrEx trial of daily oral HIV preexposure prophylaxis. Public Library of Science ONE, 8(12), e81997. https://doi.org/10.1371/journal.pone.0081997.

    PubMed  Google Scholar 

  • McCamish, M., Storer, G., & Carl, G. (2000). Refocusing HIV/AIDS interventions in Thailand: The case for male sex workers and other homosexually active men. Culture, Health & Sexuality, 2(2), 167–182.

    Article  Google Scholar 

  • McCormack, S., Dunn, D. T., Desai, M., Dolling, D. I., Gafos, M., Gilson, R., … Gill, O. N. (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.

    Article  PubMed  PubMed Central  Google Scholar 

  • McKinnon, L. R., Gakii, G., Juno, J. A., Izulla, P., Munyao, J., Ireri, N., … Kimani, J. (2014). High HIV risk in a cohort of male sex workers from Nairobi, Kenya. Sexually Transmitted Infections, 90(3), 237–242.

    Article  PubMed  Google Scholar 

  • Mimiaga, M. J., Reisner, S. L., Tinsley, J. P., Mayer, K. H., & Safren, S. A. (2009). Street workers and internet escorts: Contextual and psychosocial factors surrounding HIV risk behavior among men who engage in sex work with other men. Journal of Urban Health, 86(1), 54–66.

    Article  PubMed  Google Scholar 

  • Minichiello, V., & Scott, J. (2014). Male sex work and society. New York, NY: Harrington Park Press.

    Book  Google Scholar 

  • Minichiello, V., Scott, J., & Callander, D. (2015). A new public health context to understand male sex work. BMC Public Health, 15, 282. https://doi.org/10.1186/s12889-015-1498-7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Molina, J. M., Capitant, C., Spire, B., Pialoux, G., Cotte, L., Charreau, I., … ANRSIPERGAY 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.

    Article  PubMed  Google Scholar 

  • Mugwanya, K. K., Donnell, D., Celum, C., Thomas, K. K., Ndase, P., Mugo, N.,… Baeten, J. M., for the Partners PrEP Study Team. (2013). Sexual behavior of heterosexual men and women receiving antiretroviral pre-exposure prophylaxis for HIV prevention: A longitudinal analysis. Lancet Infectious Diseases, 13(2), 1021–1028.

  • Mustanski, B. (2007). The influence of state and trait affect on HIV risk behaviors: A daily diary study of MSM. Health Psychology, 26(5), 618–626.

    Article  PubMed  Google Scholar 

  • Namey, E., Agot, K., Ahmed, K., Odhiambo, J., Skhosana, J., Guest, G., & Corneli, A. (2016). When and why women might suspend PrEP use according to perceived seasons of risk: Implications for PrEP-specific risk-reduction counselling. Culture, Health & Sexuality, 18(9), 1081–1091.

    Article  Google Scholar 

  • National Drug Intelligence Center. (2003). Rhode Island drug threat assessment. Johnstown, PA: National Drug Intelligence Center.

  • Parsons, J. T., Rendina, H. J., Grov, C., Ventuneac, A., & Mustanski, B. (2015). Accuracy of highly sexually active gay and bisexual men’s predictions of their daily likelihood of anal sex and its relevance for intermittent event-driven HIV pre-exposure prophylaxis. Journal of Acquired Immune Deficiency Syndromes, 68(4), 449–455.

    Article  PubMed  Google Scholar 

  • Peng, P., Su, S., Fairley, C. K., Chu, M., Jiang, S., Zhuang, X., & Zhang, L. (2017). A global estimate of the acceptability of pre-exposure prophylaxis for HIV among men who have sex with men: A systematic review and meta-analysis. AIDS and Behavior. https://doi.org/10.1007/s10461-017-1675-z.

  • Pines, H. A., Gorbach, P. M., Weiss, R. E., Shoptaw, S., Landovitz, R. J., Javanbakht, M., … Plankey, M. (2014). Sexual risk trajectories among MSM in the United States: Implications for pre-exposure prophylaxis delivery. Journal of Acquired Immune Deficiency Syndromes, 65(5), 579–586.

    Article  PubMed  Google Scholar 

  • Ponterotto, J. G. (2005). Qualitative research in counseling psychology: A primer on research paradigms and philosophy of science. Journal of Counseling Psychology, 52(2), 126–136.

    Article  Google Scholar 

  • QSR International. (2012). NVivo 9. Doncaster: Australia.

  • Rendina, J., Ventuneac, A., Grov, C., Mustanski, B., & Parsons, J. (2013). Accuracy in predicting daily anal intercourse with casual partners and its relevance for intermittent PrEP: An online diary analysis of highly sexually active gay and bisexual men. Paper presented at the 8th International Conference on HIV Treatment and Prevention Adherence, Miami, FL.

  • Restar, A. J., Tocco, J. U., Mantell, J. E., Lafort, Y., Gichangi, P., Masvawure, T. B., … Sandfort, T. G. M. (2017). Perspectives on HIV pre- and post-exposure prophylaxes (PrEP and PEP) among female and male sex workers in Mombasa, Kenya: Implications for integrating biomedical prevention into sexual health services. AIDS Education and Prevention, 29(2), 141–153.

    Article  PubMed  PubMed Central  Google Scholar 

  • Reza-Paul, S., Lorway, R., O’Brien, N., Lazarus, L., Jain, J., Bhagya, M., … Steen, R. (2012). Sex worker-led structural interventions in India: A case study on addressing violence in HIV prevention through the Ashodaya Samithi collective in Mysore. Indian Journal of Medical Research, 135, 98–106.

    Article  PubMed  Google Scholar 

  • Sivay, M. V., Li, M., Piwowar-Manning, E., Zhang, Y., Hudelson, S. E., Marzinke, M. A., … Team, H. A. S. (2017). Characterization of HIV seroconverters in a TDF/FTC PrEP study: HPTN 067/ADAPT. Journal of Acquired Immune Deficiency Syndromes, 75(3), 271–279.

    Article  PubMed  Google Scholar 

  • Thigpen, M. C., Kebaabetswe, P. M., Paxton, L. A., Smith, D. K., Rose, C. E., Segolodi, T. M., … TDF2 Study Group. (2012). Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. New England Journal of Medicine, 367(5), 423–434.

    Article  PubMed  Google Scholar 

  • Underhill, K., Morrow, K. M., Colleran, C., Holcomb, R., Calabrese, S. K., Operario, D., … Mayer, K. H. (2015). 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 pre-exposure prophylaxis implementation. Journal of Urban Health, 92(4), 667–686.

    Article  PubMed  PubMed Central  Google Scholar 

  • Underhill, K., Morrow, K. M., Colleran, C. M., Holcomb, R., Operario, D., Calabrese, S. K., … Mayer, K. H. (2014). Access to healthcare, HIV/STI testing, and preferred pre-exposure prophylaxis providers among men who have sex with men and men who engage in street-based sex work in the US. Public Library of Science ONE, 9(11), e112425. https://doi.org/10.1371/journal.pone.0112425.

    PubMed  Google Scholar 

  • Van der Elst, E. M., Mbogua, J., Operario, D., Mutua, G., Kuo, C., Mugo, P., … Sanders, E. J. (2013). High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: Qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya. AIDS and Behavior, 17(6), 2162–2172.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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 in the United States: Implications for event-based intermittent pre-exposure prophylaxis. Journal of Acquired Immune Deficiency Syndromes, 61(1), 112–115.

    Article  PubMed  Google Scholar 

  • Williams, M. L., Bowen, A. M., Timpson, S. C., Ross, M. W., & Atkinson, J. S. (2006). HIV prevention and street-based male sex workers: An evaluation of brief interventions. AIDS Education and Prevention, 18(3), 204–215.

    Article  PubMed  Google Scholar 

  • Young, I., & McDaid, L. (2014). How acceptable are antiretrovirals for the prevention of sexually transmitted HIV? A review of research on the acceptability of oral pre-exposure prophylaxis and treatment as prevention. AIDS and Behavior, 18(2), 195–216.

    Article  PubMed  Google Scholar 

  • Zhang, X., Zhong, L., Romero-Severson, E., Alam, S. J., Henry, C. J., Volz, E. M., & Koopman, J. S. (2012). Episodic HIV risk behavior can greatly amplify HIV prevalence and the fraction of transmissions from acute HIV infection. Statistical Communications in Infectious Diseases, 4(1), 1041. https://doi.org/10.1515/1948-4690.1041.

  • Ziersch, A., Gaffney, J., & Tomlinson, D. R. (2000). STI prevention and the male sex industry in London: Evaluating a pilot peer education programme. Sexually Transmitted Infections, 76(6), 447–453.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This study was supported by the National Institute of Mental Health, 5K01MH093273 (PI: Underhill). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article. S.K. Calabrese and K.H. Mayer have received compensation for their efforts in developing and/or delivering medical education related to PrEP. K.H. Mayer has conducted research with unrestricted project support from Gilead Sciences, Merck, and ViiV Healthcare. S.K. Calabrese was supported by 5K01MH103080 from the National Institute of Mental Health (NIMH). K.M. Guthrie was supported by 5K24HD062645 from the National Institute of Child Health and Human Development. We are grateful to the study participants, Project Weber, Miriam Community Access, the Yale Center for Interdisciplinary Research on AIDS, the Lifespan/Tufts/Brown Center for AIDS Research, Melissa Guillen, Genevieve Ilg, Bobby Ducharme, and Dr. Caroline Kuo for help during the implementation of this study. Kristen Underhill and Sarah Calabrese were both based at Yale University when this work was conducted.

Author information

Authors and Affiliations

  1. Columbia Law School, Columbia University, 435 W 116th St., New York, NY, 10027, USA

    Kristen Underhill

  2. Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA

    Kristen Underhill

  3. Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA

    Kate M. Guthrie & Christopher Colleran

  4. Department of Psychology, George Washington University, Washington, DC, USA

    Sarah K. Calabrese

  5. School of Public Health, Brown University, Providence, RI, USA

    Don Operario

  6. The Fenway Institute, Fenway Health, Boston, MA, USA

    Kenneth H. Mayer

  7. Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA

    Kate M. Guthrie

Authors
  1. Kristen Underhill
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kate M. Guthrie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher Colleran
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sarah K. Calabrese
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Don Operario
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenneth H. Mayer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kristen Underhill.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Underhill, K., Guthrie, K.M., Colleran, C. et al. Temporal Fluctuations in Behavior, Perceived HIV Risk, and Willingness to Use Pre-Exposure Prophylaxis (PrEP). Arch Sex Behav 47, 2109–2121 (2018). https://doi.org/10.1007/s10508-017-1100-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-017-1100-8

Keywords

Search

Navigation