Changes in Familiarity with and Willingness to Take Preexposure Prophylaxis in a Longitudinal Study of Highly Sexually Active Gay and Bisexual Men.

Abstract

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. 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). 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. 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.