Should I Convince My Partner to Go on Pre-Exposure Prophylaxis (PrEP)? The Role of Personal and Relationship Factors on PrEP-Related Social Control among Gay and Bisexual Men

Abstract

An estimated 35-68% of new HIV infections among gay, bisexual, and other men who have sex with men (GBM) are transmitted through main partnerships. Pre-exposure prophylaxis (PrEP) is highly effective in reducing HIV seroconversion, yet PrEP uptake has been modest. PrEP-naïve GBM with HIV-negative, PrEP-naïve main partners enrolled in One Thousand Strong (n = 409), a U.S. national cohort of GBM, were asked about (1) the importance of partner PrEP use and (2) their willingness to convince their partner to initiate PrEP. On average, participants thought partner PrEP was only modestly important and were only moderately willing to try to convince their partner to initiate PrEP. Personal PrEP uptake willingness and intentions were the strongest indicators of partner PrEP outcomes. Being in a monogamish relationship arrangement (as compared to a monogamous arrangement) and the experience of intimate partner violence victimization were associated with increased willingness to persuade a partner to initiate PrEP.

An Examination of Gay Couples’ Motivations to Use (or Forego) Pre-exposure Prophylaxis Expressed During Couples HIV Testing and Counseling (CHTC) Sessions

“…This is consistent with a broader literature on HIV-risk perception among monogamous GBM. Those in monogamous relationships report testing less-frequently than their open and single counterparts (Stephenson et al, 2015), use condoms less frequently (Sullivan et al, 2009) and find PrEP to be less important than men in open relationships (John et al, 2018). The idea that PrEP would be useful if “the need arose” is also consistent with concerns identified in previous literature wherein monogamous men worried that discussing PrEP with a partner would generate worries that they had violated their sexual agreement (Mimiaga et al, 2014).…”

“…Similarly, the sample was restricted to couples in which at least one partner was reported to use substances. Previous research suggests that partnered gay men who use substances are more willing to persuade their partners to use PrEP compared to those who do not (John et al, 2018). …”

“…Sexual agreements also predict GBM’s perception of their partners’ need for HIV prevention. GBM in monogamous relationships perceive PrEP use to be less important for their partner compared to men in non-monogamous relationships (John, Starks, Rendina, Grov, & Parsons, 2018). Monogamous GBM report concerns that discussing PrEP will cause their partners to become concerned about agreement violations (Mimiaga, Closson, Kothary, & Mitty, 2014).…”

Drug Use and HIV Prevention With Young Gay and Bisexual Men: Partnered Status Predicts Intervention Response

“…Finally, the current study was executed prior to the emergence of pre-exposure prophylaxis. Studies of male couples suggest that more than half of partnered MSM are interested in PrEP for HIV prevention[47, 48] and personal interest in PrEP is a significant predictor of willingness to persuade one’s partner to use PrEP[49]. Future studies of YMHP should incorporate a focus on PrEP and specifically examine how partners’ interactions shape PrEP-related decision making.…”

“…Gay couples frequently utilize sexual agreements – understandings about the boundaries and limitations on sex with partners outside the relationship – as a mechanism to manage HIV-related risk[22, 23]. Research on sexual agreements has typically distinguished between monogamous agreements (those in which sex with partners outside the relationship is not permitted) and non-monogamous agreements (those in which some kinds of sexual behavior with outside partners may occur)[22, 46, 49]. Some have distinguished between subtypes of non-monogamy in which sex with a casual partner may only occur when both main partners are present – termed “monogamish” – and those in which the partners in the primary relationship may have sex with outside partners independently [26].…”