Distinguishing hypothetical willingness from behavioral intentions to initiate HIV pre-exposure prophylaxis (PrEP): Findings from a large cohort of gay and bisexual men in the U.S.

Rendina, H. Jonathon; Whitfield, Thomas H. F.; Grov, Christian; Starks, Tyrel J.; Parsons, Jeffrey T.

doi:10.1016/j.socscimed.2016.10.030

Cited by 71 publications

(76 citation statements)

References 43 publications

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“…Recent research has identified inconsistencies in hypothetical willingness and actual intentions in PrEP uptake, highlighting limits inherent in acceptability research. 36 All MSM in this study were currently taking daily oral PrEP, demonstrating an established willingness to take this medication. By asking participants to rank each formulation and indicate whether or not they prefer each form to daily oral PrEP, our measures of preference may circumvent the ''willingness'' versus ''intentions'' disconnect.…”

Section: Discussionmentioning

confidence: 92%

Next-Generation HIV Pre-Exposure Prophylaxis Preferences Among Men Who Have Sex with Men Taking Daily Oral Pre-Exposure Prophylaxis

Ellison

Berg

Montgomery

et al. 2019

AIDS Patient Care and STDs

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Next-generation forms of HIV pre-exposure prophylaxis (PrEP) currently in development, including long-acting injectables (LAIs), rectal microbicides (RMs), antibody infusions (AIs), and subdermal implants (SIs), may address barriers to daily oral PrEP uptake and adherence. The purpose of this study was to evaluate barriers to oral PrEP, preferences for next-generation PrEP modalities, sociodemographic characteristics and sexual behaviors associated with preferences, and reasons for wanting or not wanting each formulation among a sample of men who have sex with men (MSM). We administered a cross-sectional survey to a diverse sample of MSM currently taking oral PrEP (n = 108) at two sexually transmitted disease clinics. We used logistic multivariate analyses to explore preferences, relative to oral PrEP, for each formulation across sociodemographic and sexual behaviors. The most commonly endorsed barriers were finding a PrEP provider and making appointments to get PrEP. Participants were most likely to prefer the SI (45%), followed by the LAI (31%), pill (21%), RM (1%), and AI (1%). Black/African American and Hispanic/Latino MSM were more likely to prefer the LAI over daily oral PrEP (odds ratio: 2.45, 95% confidence interval: 0.86-6.89), and sexual behaviors were most commonly associated with preference for the SI. Top reasons for wanting or not wanting each formulation were most commonly related to perceived ease of use. These findings demonstrate variations in preferences for next-generation PrEP modalities, highlighting a need to ensure comprehensive access to all formulations once they become available.

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Section: Discussionmentioning

confidence: 92%

Next-Generation HIV Pre-Exposure Prophylaxis Preferences Among Men Who Have Sex with Men Taking Daily Oral Pre-Exposure Prophylaxis

Ellison

Berg

Montgomery

et al. 2019

AIDS Patient Care and STDs

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“…In conceptualizing the transition from Precontemplation through Contemplation and PrEParation, the distinction between willingness versus intentions or opportunity emerged as a critical aspect of the Motivational PrEP Cascade based on earlier work [27]. Not all GBM who were open (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Among the 301 GBM who completed both processes in the Contemplation stage (meaning they were willing to take PrEP and believed they were an appropriate candidate), the majority (81%) reported having access to a PrEP provider, though fewer (57.5%) reported intentions to begin PrEP. The incorporation of the motivational concept of “intentions” in this stage identifies a potentially critical point of intervention to enhance PrEP uptake [27]. Providers could consider a decisional balance exercise of the pros and cons of PrEP uptake [28, 29].…”

Section: Discussionmentioning

confidence: 99%

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Uptake of HIV Pre-Exposure Prophylaxis (PrEP) in a National Cohort of Gay and Bisexual Men in the United States

Parsons

Rendina

Lassiter

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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253

224

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Objectives The HIV care cascade provides milestones to track the progress of HIV-positive people from seroconversion through viral suppression. We propose a Motivational PrEP Cascade involving five stages based upon the Transtheoretical Model of Change. Methods We analyzed data from 995 men in One Thousand Strong, a longitudinal study of a national panel of HIV-negative gay and bisexual men in the United States. Results Nearly all (89%) participants were sexually active in the past 3 months, and 65% met CDC criteria for PrEP candidacy. Of those identified as appropriate candidates, 53% were Precontemplative (Stage 1; unwilling to take or believing they were inappropriate candidates for PrEP) and 23% were in Contemplation (Stage 2; willing and self-identified as appropriate candidates). Only 11% were in PrEParation (Stage 3; seeing PrEP as accessible and planning to initiate PrEP) and 4% were in PrEP Action (Stage 4; prescribed PrEP). Although few of those who were identified as appropriate candidates were on PrEP, nearly all PrEP users (98%) reported adhering to 4 or more doses per week and most (72%) were returning for recommended quarterly medical visits, resulting in 9% of PrEP candidates reaching Maintenance and Adherence (Stage 5). Conclusions A large majority of participants were appropriate candidates for PrEP, yet fewer than 1 in 10 were using and adherent to PrEP. These findings highlight the need for interventions tailored to address the unique barriers men face at each stage of the cascade, particularly at the earliest stages where the most dramatic losses were identified.

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“…Recent research generally indicates a high degree of ambivalence about PrEP among men, with one recent study revealing almost equal numbers of men unwilling (42%) and willing (41%) to take PrEP (Rendina et al, 2017). In a survey of nearly 1000 gay and bisexual men across the U.S., Parsons et al (2017) found that 53% of men who met the criteria established by the CDC were unwilling to take PrEP or did not believe they were appropriate candidates.…”

Section: Prep Public Health and Sexual Culturementioning

confidence: 99%

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

et al. 2019

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Pre-exposure prophylaxis (PrEP) with Truvada has emerged as an increasingly common approach to HIV prevention among gay, bisexual, and other men who have sex with men. This study examined generational differences and similarities in narrative accounts of PrEP among a diverse sample of 89 gay and bisexual men in the U.S. Over 50% of men in the older (52-59 years) and younger (18-25 years) generations endorsed positive views, compared with 32% of men in the middle (34-41 years) generation. Men in the middle cohort expressed the most negative (21%) and ambivalent (47%) views of PrEP. Thematic analysis of men's narratives revealed three central stories about the perceived impact of PrEP: (1) PrEP has a positive impact on public health by preventing HIV transmission (endorsed more frequently by men in the older and younger cohorts); (2) PrEP has a positive effect on gay and bisexual men's sexual culture by decreasing anxiety and making sex more enjoyable (endorsed more frequently by men in the middle and younger cohorts); and (3) PrEP has a negative impact on public health and sexual culture by increasing condomless, multi-partner sex (endorsed more frequently by men in the middle and younger cohorts). Results are discussed in terms of the significance of generation cohort in meanings of sexual health and culture and implications for public health approaches to PrEP promotion among gay and bisexual men.

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Distinguishing hypothetical willingness from behavioral intentions to initiate HIV pre-exposure prophylaxis (PrEP): Findings from a large cohort of gay and bisexual men in the U.S.

Cited by 71 publications

References 43 publications

Next-Generation HIV Pre-Exposure Prophylaxis Preferences Among Men Who Have Sex with Men Taking Daily Oral Pre-Exposure Prophylaxis

Next-Generation HIV Pre-Exposure Prophylaxis Preferences Among Men Who Have Sex with Men Taking Daily Oral Pre-Exposure Prophylaxis

Uptake of HIV Pre-Exposure Prophylaxis (PrEP) in a National Cohort of Gay and Bisexual Men in the United States

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

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