Condom-Use Decision Making in the Context of Hypothetical Pre-Exposure Prophylaxis Efficacy Among Substance-Using Men Who Have Sex With Men: Project MIX
ABSTRACT To examine condom-use decision making in the context of hypothetical pre-exposure prophylaxsis (PrEP) efficacy among men who have sex with men who use alcohol and other substances during sex.
Substance-using men who have sex with men were recruited in 4 US cities for a behavioral intervention trial. Three groups were defined as follows: men who indicated that to not use a condom for receptive/insertive unprotected anal intercourse (UAI) while using PrEP, PrEP would need to be: (1) "almost always or always" effective (high efficacy); (2) effective "at least half the time or more but not almost always or always" (mid-range efficacy corresponding to recent PrEP trial results); (3) effective "less than half the time" (low efficacy). The mid-range efficacy group was compared with the low-efficacy group (as the reference) and to the-high efficacy group (as the reference).
Among 630 men who never used PrEP, 15.2% were in the mid-range efficacy group for receptive UAI and 34.1% in the mid-range efficacy group for insertive UAI. Scores on difficulty communicating about safer sex while high were significantly higher in the mid-range efficacy group compared with each of the other groups for both receptive and insertive UAI. Men who seemed to be differentiating PrEP use by anal sex role also scored higher on communication difficulties, although scoring lower on condom intentions.
Communication about safer sex while under the influence of alcohol or other substances and condom intentions are important factors to consider for HIV prevention interventions for PrEP users.
- American Journal of Preventive Medicine 01/2013; 44(1):S80–S85. DOI:10.1016/j.amepre.2012.09.036 · 4.28 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: To investigate willingness to use HIV pre-exposure prophylaxis (PrEP) and the likelihood of decreased condom use among Australian gay and bisexual men. A national, online cross-sectional survey was conducted in April to May 2011. Bivariate relationships were assessed with χ2 or Fisher's exact test. Multivariate logistic regression analysis was performed to assess independent relationships with primary outcome variables. Responses from 1161 HIV-negative and untested men were analysed. Prior use of antiretroviral drugs as PrEP was rare (n=6). Just over a quarter of the sample (n=327; 28.2%) was classified as willing to use PrEP. Willingness to use PrEP was independently associated with younger age, having anal intercourse with casual partners (protected or unprotected), having fewer concerns about PrEP and perceiving oneself to be at risk of HIV. Among men who were willing to use PrEP (n=327), only 26 men (8.0%) indicated that they would be less likely to use condoms if using PrEP. The likelihood of decreased condom use was independently associated with older age, unprotected anal intercourse with casual partners (UAIC) and perceiving oneself to be at increased risk of HIV. The Australian gay and bisexual men the authors surveyed were cautiously optimistic about PrEP. The minority of men who expressed willingness to use PrEP appear to be appropriate candidates, given that they are likely to report UAIC and to perceive themselves to be at risk of HIV.Sexually transmitted infections 01/2012; 88(4):258-63. DOI:10.1136/sextrans-2011-050312 · 3.08 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: In light of recent research, Gordon Mansergh and colleagues discuss barriers to effective implementation of HIV pre-exposure prophylaxis for men who have sex with men.PLoS Medicine 08/2012; 9(8):e1001286. DOI:10.1371/journal.pmed.1001286 · 14.00 Impact Factor