A new theoretical model of understanding pre-exposure prophylaxis (PrEP) use intention in men who have sex with men (MSM) highlights the complexity of decision-making about PrEP in MSM while providing insights into strategies for effective intervention, according to a study published in AIDS and Behavior.
MSM account for an estimated 65% of new HIV infections, despite being only 2% to 5% of the US population. A 20% decrease in condom use from 2005 to 2011 is likely a major contributing factor. To address this epidemic, PrEP using Truvada® is recommended and has demonstrated a 92% decrease in the rate of seroconversion in MSM. However, PrEP uptake in MSM remains low. Many factors, including motivation to maintain intimacy with condom-less sex, safe sex fatigue (a state in which maintaining safe sex behavior is perceived as burdensome), lack of awareness, side effects, perceived risk, and self-efficacy are factors that influence PrEP use intention. To develop successful preventative strategies that both acknowledge and address issues related to perceived barriers posed by condoms and promote facilitators that drive interest in using PrEP, awareness of this decision-making process is crucial. Despite this, few studies have used theoretical models to understand the process by which these predictors interact and influence each other to affect the decision to use PrEP. Thus, this study proposes a novel theoretical model that examines the relationship between motivating factors for use of PrEP in MSM.
To test the hypothetical model, a structural equation modeling (SEM) was used that provides flexibility to examine the interrelationships between dependent and independent variables. Using social networking applications (apps) commonly used by MSM (Grindr, Hornet, Scruff, and Growlr), a standardized script was used to messaged-selected app users, and interested participants received a link directing users to the survey, where eligibility was assessed. These criteria included: self-identifying as MSM, 21 or older, self-reported HIV-negative status, and no previous history of using Truvada for PrEP. A total of 402 participants were included in the study. Number of sexual partners, negative attitude towards condoms, safe sex fatigue, sexual expectancy on PrEP, perceived risk, and PrEP use intention were all measured as part of the study.
Results presented a new theoretical model of understanding PrEP use intention in MSM: The Dual Motivational Model of PrEP use intention. This model suggests 2 important paths that influence PrEP use intention: (1) expectancy motivation pathway (the motivation to have better sexual experiences on PrEP), and (2) protection motivation pathway (the expectation of protecting oneself from HIV).
Higher rates of safe sex fatigue were directly associated with an increased negative attitude towards condoms, which in turn had a direct and positive influence on higher sexual expectancy on PrEP (P <.01). PrEP use intention was directly related to having a higher sexual expectancy (P <.01) and perceived risk (P <.05) and inversely related to age. The number of sexual partners in the past 6 months had an indirect positive effect on PrEP use intention (P <.01), mediated by 4 variables: (1) safe sex fatigue, (2) negative attitude towards condoms, (3) sexual expectancies while on PrEP, and (4) perceived risk.
Overall, investigators concluded that, “Evidence from this study suggests that HIV campaigns need to position and market PrEP as an additional protective strategy to supplement condom use, and as a safety net for times where there are gaps in condom use.”
Ranjit YS, Dubov A, et al. Pre-exposure prophylaxis among men who have sex with men: dual motivational model of intention to use pre-exposure prophylaxis [published online July 6, 2018]. AIDS and Behavior. doi:10.1007/s10461-018-2214-2