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Individual, Interpersonal, and Structural Factors That Influence Intentions to Use Pre-exposure Prophylaxis Among Sexual Minority Men in Miami

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Abstract

Pre-exposure prophylaxis for HIV or “PrEP” holds great promise for reducing HIV incidence. However, in certain geographic settings, like Miami, a US HIV epicenter, uptake of PrEP has been paradoxically very low compared to other areas of the country. The goal of the current study was to examine factors associated with low uptake of PrEP in young sexual minority men in Miami. Qualitative data were extracted from conversations during voluntary HIV/STI counseling and testing sessions with 24 young sexual minority men, most of whom identified as racial/ethnic minorities. These sessions were completed as part of a baseline visit for a combined mental and sexual health intervention trial. Thematic analysis of transcripts revealed barriers and facilitators associated with PrEP uptake at multiple levels (individual, interpersonal, and economic and healthcare systems barriers). Individual-level themes included concerns about the safety of PrEP, risk compensation, and taking daily oral medication; and potential benefits of PrEP as a backup plan to condom use to reassure and reduce worry about HIV. Interpersonal-level themes included lack of knowledgeable and affirming medical providers, changing norms within the community around “safe sex,” and PrEP use in serodiscordant partnerships. Economic and healthcare systems barriers included challenges to accessing PrEP because of a lack of insurance and high out-of-pocket cost. These data can be used to inform the development of interventions aligned with Ending the HIV Epidemic priorities to increase PrEP use among young sexual minority men living in an HIV epicenter.

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Notes

  1. We use men who have sex with men (MSM) and sexual minority men (SMM) throughout the article. In describing our own work, we use the term SMM, which represents the identities of the participants in our study, all of whom identified as SMM. However, in referring to others’ work, we use the term that reflects their original language.

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Acknowledgements

We would like to acknowledge and thank Kyle Hafkey and Christopher Albright for help with coding the data. We would also like to thank Kyle Hafkey, Jacqueline Rodriguez, and Emily Deutsch for their help transcribing the audio files.

Funding

This work was supported by the National Institute of Mental Health under R01MH109413 (Pachankis). Author time was also supported by the National Institute of Mental Health under Grant F31MH113481 (Rogers) and K23MD015690 (Harkness); the National Institute of Allergy and Infectious Disease and Providence/Boston Center for AIDS Research (CFAR) P30AI042853 (Rogers); and the National Institute on Drug Abuse under Grant 9K24DA040489 (Safren).

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Authors and Affiliations

  1. Department of Medicine, Warren Alpert Medical School of Brown University, 11 Fourth Street, Providence, RI, 02906, USA

    Brooke G. Rogers

  2. Department of Medicine, Infectious Diseases, The Miriam Hospital, Providence, RI, USA

    Brooke G. Rogers

  3. Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA

    Brooke G. Rogers, Audrey Harkness, Satyanand Satyanarayana & Steven A. Safren

  4. Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami, Miami, FL, USA

    Audrey Harkness

  5. Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA

    John Pachankis

  6. The Fenway Institute, Boston, MA, USA

    Steven A. Safren

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  1. Brooke G. Rogers
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  2. Audrey Harkness
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  3. Satyanand Satyanarayana
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  4. John Pachankis
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Contributions

B.G.R. was responsible for the original study conception. B.G.R. and A.H. led qualitative analyses. B.G.R. wrote the first full draft, and all authors provided comments and edits. All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by B.G.R. and A.H. S.S. assisted with qualitative coding and data analysis. The first draft of the manuscript was written by B.G.R., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Brooke G. Rogers.

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Conflict of interest

Dr. Brooke Rogers receives scientific funding from Gilead Sciences #IN-US-276-5463 to implement PrEP in the correctional setting. Dr. Steven Safren receives royalties from Oxford University Press, Springer/Humana Press, and Guilford Publications for books that focus on different CBT and motivational interviewing approaches. Dr. John Pachankis and Dr. Audrey Harkness receive royalties from Oxford University Press for books related to LGBTQ-affirmative mental health treatments. There are no other conflicts of interest to report.

Ethics Approval

Approval was obtained from the Human Subjects Committee of Yale University and the Institutional Review Board of the University of Miami.

Consent to Participate

All participants provided consent to participate in the study.

Consent to Publish

All participants provided consent to research processes and publishing of their data.

Informed Consent

All participants provided written informed consent prior to study participation. The study procedures and materials were approved by The Human Subjects Committee of Yale University School of Public Health and the Institutional Review Board of the University of Miami.

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Rogers, B.G., Harkness, A., Satyanarayana, S. et al. Individual, Interpersonal, and Structural Factors That Influence Intentions to Use Pre-exposure Prophylaxis Among Sexual Minority Men in Miami. Arch Sex Behav 52, 741–750 (2023). https://doi.org/10.1007/s10508-021-02263-7

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