Changes in Familiarity with and Willingness to Take Preexposure Prophylaxis in a Longitudinal Study of Highly Sexually Active Gay and Bisexual Men (original) (raw)
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AIDS and Behavior, 2015
Once-daily Truvada (Emtricitabine/Tenofovir) as a method of pre-exposure prophylaxis (PrEP) is one of the most promising biomedical interventions to eliminate new HIV infections; however, uptake among gay, bisexual, and other men who have sex with men has been slow amidst growing concern in popular/social media that PrEP use will result in reduced condom use (i.e., risk compensation). We investigated demographic, behavioral, and psychosocial differences in willingness to use PrEP as well as the perceived impact of PrEP on participants' condom use in a sample of 206 highly sexually active HIV-negative gay and bisexual men. Nearly half (46.1 %) said they would be willing to take PrEP if it were provided at no cost. Although men willing to take PrEP (vs. others) reported similar numbers of recent casual male partners (\6 weeks), they had higher odds of recent receptive
Grov et al 2016 LGBTHealth PrEP in PT.pdf
Purpose: For gay and bisexual men (GBM), research suggests that familiarity with preexposure prophylaxis (PrEP) has been increasing since being approved by the United States Food and Drug Administration in 2012. However, it is less clear how willingness to start using PrEP has changed over time. Likewise, some have expressed concerns regarding the potential for risk compensation (i.e., reduced condom use) were one to start PrEP; however, again, it is unclear how risk compensation may have changed over time. Methods: We conducted baseline and 12-month assessments with 158 highly sexually active HIV-negative GBM in New York City who were assessed between 2011 and 2014. We examined change over time both between participants (based on when they entered the study), as well as within each participant (over the 12 months of his involvement). Results: Familiarity with PrEP increased over time (both between and within participants); however, willingness to take PrEP did not change (neither between nor within participants). Few men believed taking PrEP would cause their condomless anal sex (CAS) to increase and this did not change over time. However, a majority believed PrEP would increase temptation for CAS, and this did not change over time within participants. Sexual compulsivity symptomology was associated with higher willingness to take PrEP and perceiving that PrEP would increase one's temptations for CAS. Furthermore, recent CAS was associated with greater willingness to take PrEP, a perception that PrEP would increase one's likelihood to engage in CAS, and a perception that being on PrEP would increase one's temptation for CAS. Conclusions: Participants became more familiar with PrEP over time; however, willingness to start PrEP did not change, and this may serve as an opportunity for providers to discuss PrEP with their patients. Men who engaged in CAS were interested in PrEP and preexisting patterns of sexual behavior may be the primary determinant of CAS while on PrEP.
EClinicalMedicine, 2020
Background: Optimising HIV pre-exposure prophylaxis (PrEP) provision requires insight into preferences of PrEP regimens and PrEP discontinuation. We assessed regimen switching and discontinuation and their determinants among men who have sex with men (MSM) participating in the Amsterdam PrEP demonstration project. Methods: Between 3-August-2015 and 31-May-2016, we enrolled MSM (n = 374) and TGP (n = 2) in a prospective, longitudinal study. Participants could choose between daily or event-driven PrEP regimens at enrolment and every 3 months. We assessed transition intensities (TI) and determinants of switching (i) between regimens, and (ii) from either regimen to discontinuing PrEP using a multi-state Markov model. PrEP discontinuation was defined as formally stopping study participation or having no study visit for 6 months. Findings: Of 367 analysed participants, 73¢3% chose daily and 26¢7% event-driven PrEP at enrolment. Median follow-up was 3¢1 years (IQR 2¢9À3¢2). 121 participants switched their PrEP regimen at least once (cumulative probability 34¢2%, 95% CI 29¢4À39¢6), with 90 switches from event-driven to daily PrEP (TI 0¢35/PY, 95% CI 0¢29À0¢44) and 113 switches from daily to event-driven PrEP (TI 0¢16/PY, 95% CI 0¢13À0¢20). Switching from event-driven to daily PrEP was associated with younger age, not reporting sex with HIV-positive partners, chemsex, and sexual compulsivity. Switching from daily to event-driven PrEP were associated with younger age and lower sexual satisfaction. 67 participants discontinued PrEP (cumulative probability 17¢7%, 95% CI 14¢1À22¢2), with no difference between regimens: event-driven (n = 23, TI 0¢08/PY, 95% CI 0¢05À0¢13) and daily PrEP (n = 44, TI 0¢06/PY, 95% CI 0¢04À0¢08). Discontinuing daily PrEP was associated with younger age, fewer casual partners, and higher number of condomless anal sex acts with casual partners. Interpretation: Switching between PrEP regimens was common, while going from event-driven to daily PrEP use was associated with certain sexual-related determinants (i.e. chemsex, sexual compulsivity, no known HIV-positive partners). PrEP discontinuation rates were low and independent of regimens. PrEP care should consider the reasons for choice and switch of regimen and involve education on safely switching or discontinuing PrEP, especially among younger MSM.
PLOS ONE, 2018
Background Phase III trials of long-acting injectable (LAI) PrEP, currently underway, have great potential for expanding the menu of HIV prevention options. Imagining a future in which multiple PrEP modalities are available to potential users of biomedical HIV prevention, we investigated which factors might help direct a patient-physician shared-decision making process to optimize the choice of biomedical HIV prevention method. Methods Participants (n = 105; ages 19-63; 46.7% men of color) were former participants in a PrEP demonstration project and had taken daily oral PrEP for ! 12 months. Participants were given information about LAI PrEP and asked whether they would be interested in switching from oral to LAI PrEP. Participants were also asked about specific pros/cons of LAI PrEP, PrEP attitudes and experiences, and personality factors. Results Two-thirds (66.7%) of current oral PrEP users would switch to LAI PrEP. Intention to switch was associated with product-level and psychosocial factors. Attitudes towards logistical factors (i.e. getting to regular clinic visits for recurring shots) featured more prominently than factors related to the physical experience of PrEP modality (i.e., concerns about injection pain) as motivators for switching. In a multivariate regression model, psychosocial factors including the emotional burden of daily pill taking, deriving a sense of responsibility from PrEP use, and self-identifying as an early adopter, were the strongest predictors of switching.
AIDS and behavior, 2018
Using cross-sectional data from an ongoing cohort study of young gay, bisexual, and other men who have sex with men (N = 492), we examined the extent to which cognitive factors such as beliefs about the end of AIDS, concerns about the manner in which PrEP works, and perceptions about risk of contracting HIV, are related to PrEP uptake and use. While almost all participants indicted awareness of PrEP, a mere 14% had ever used PrEP. Those with lower concerns about the side effects of PrEP and greater belief that treatment and PrEP would eliminate AIDS were also more likely to have ever used PrEP. Our findings support the ongoing challenges of PrEP uptake as means of curtailing HIV in young sexual minority men, and suggest that beyond the structural factors, consideration must be given to further educating the population as a means of adjusting potentially faulty beliefs, concerns, and perceptions which may influence PrEP utilization.
AIDS and behavior, 2017
We describe changes in sexual behaviors among men who have sex with men (MSM) following initiation of pre-exposure prophylaxis (PrEP) in a clinic-based sample of MSM initiating PrEP in Providence, Rhode Island. Data were collected at baseline, 3, and 6 months following PrEP initiation including total number of anal sex partners and condom use. A longitudinal mixed effects model assessed changes in number of partners and condom use over time, adjusting for age, race, and education. There was no statistically significant difference in total number of partners over time. There was a significant increase in number of condomless anal sex partners at the 6-month visit compared to baseline (mean change +1.31 partners, 95% confidence interval 0.09-2.53, P = 0.035). As condomless anal sex may increase following PrEP uptake, adherence counseling and efforts to retain patients in PrEP care, especially during periods of non-condom use, are important as PrEP is more widely implemented.
High Interest in Pre-exposure Prophylaxis Among Men Who Have Sex with Men at Risk for HIV-Infection
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2014
Background: Preexposure prophylaxis (PrEP) is the first biomedical intervention with proven efficacy to reduce HIV acquisition in men who have sex with men (MSM) and transgender women. Little is known about levels of interest and characteristics of individuals who elect to take PrEP in real-world clinical settings. Methods: The US PrEP Demonstration Project is a prospective open-label cohort study assessing PrEP delivery in municipal sexually transmitted disease clinics in San Francisco and Miami and a community health center in Washington, DC. HIV-uninfected MSM and transgender women seeking sexual health services at participating clinics were assessed for eligibility and offered up to 48 weeks of emtricitabine/tenofovir for PrEP. Predictors of enrollment were assessed using a multivariable Poisson regression model, and characteristics of enrolled participants are described. Results: Of 1069 clients assessed for participation, 921 were potentially eligible and 557 (60.5%) enrolled. In multivariable analyses, participants from Miami (adjusted Relative Risk [aRR]: 1.53; 95% confidence interval [CI]: 1.33 to 1.75) or DC (aRR: 1.33; 95% CI: 1.2 to 1.47), those who were self-referred (aRR: 1.48; 95% CI: 1.32 to 1.66), those with previous PrEP awareness (aRR: 1.56; 95% CI: 1.05 to 2.33), and those reporting .1 episode of anal sex with an HIV-infected partner in the last 12 months (aRR: 1.20; 95% CI: 1.09 to 1.33) were more likely to enroll. Almost all (98%) enrolled participants were MSM, and at baseline, 63.5% reported condomless receptive anal sex in the previous 3 months. Conclusions: Interest in PrEP is high among a diverse population of MSM at risk for HIV infection when offered in sexually transmitted disease and community health clinics.
2018
This dissertation is dedicated to all the people who have been instrumental in encouraging me to never give up. My mother, the strongest bravest woman I have the privilege to know and love; my father, who always encouraged me to take on life's challenges and think about the details later, I wish you were here today to see how far I have come; Mags, who has always been able to make me realize just how fortunate I am; L.B. for all the love and support and for keeping me laughing over the years; Meres for always believing I could do this and to all my friends and family who support me even if they don't understand what it is I am doing. Most importantly, to Jono, for showing me I am capable of so much more than I realize. I would like to thank the many individuals who have supported me during my PhD journey. I would like to express my sincerest gratitude to my advisor, Dr. Carmen Portillo and my dissertation committee Drs. Cherrie B. Boyer and Glen-Milo Santos for sharing their knowledge, guidance, and time. I would also like to thank Dr. Bruce Cooper for all his support, patience and statistical education, Dr. Carol Dawson Rose, Dr. Cedric-Crouch and Dr. David Vlahov for their support throughout the PhD process. I would like to say a big thank you to Dr. Glenda Baguso for all the soup, library time, encouraging me to submit abstracts and explore educational experiences outside of my comfort zone; Dr. Ilufredo Tantoy for keeping it all in perspective with his kindness and support. To all the Magnet volunteers, front desk staff, support services staff, benefits navigators, nurses, nurse practitioners who on a daily basis make a positive impact on the lives of gay, bi, and trans men and women. To all the clients who graciously allowed iv me to not only provide healthcare but were generous in supplying the data for this study.
ProQuest Dissertations Publishing, 2020
Risky sexual behaviors (e.g., engaging in condomless sex) are a leading cause of disease (e.g., sexually transmitted infections) and burden on people and families in the United States and across the globe. The United States has a longstanding history of pathologizing human anatomy and sex through negative messaging, resulting in the stigmatizing of sexual behaviors, sexually transmitted infections, and homosexual behaviors. Discussions between men who have sex with men and their primary care doctors regarding the promotion of sexual health are lacking, despite research showing men are engaging in condomless anal sex within this population. Recent medical and pharmacological advances have been approved to help slow the rate of HIV infection. However, some research suggests this has led to an increase in risky sexual behaviors and condomless sex among men who have sex with men population. Most patients believe it should be their primary care physician who talks to them about issues concerning sexual health and disease prevention; however, many primary care physicians lack a comprehensive knowledge of sex or may not have the necessary time to discuss each patient’s sexual practices and how to reduce risky sexual behaviors. As such, this study seeks to identify variables that are associated with lower stages of change (i.e., due to inconsistent condom use), as well as variables that are correlated with either taking PrEP or being HIV positive. This study found the factors that may suggest lower SOC, and thus increased risk for STIs/HIV, include: being monogamous, having a higher income, having a history of a STI diagnosis, having a HIV positive diagnosis, or already taking PrEP. Being HIV positive is being associated with increased age, higher levels of education, and receiving sexual education from a primary care physician. Taking PrEP is being associated with living in the coastal United States or abroad, higher incomes, having a history of a diagnosis for a sexually transmitted infection, and receiving sexual education from a primary care physician. While these findings suggest individuals are talking to their primary care doctors about sexual health, consistent condom use is found to be low. As such, the findings in this study make a case for the integration of behavioral health professionals (e.g., psychologists) into primary care physicians’ offices to provide interventions to patients regarding risky sexual behaviors.