271226 A qualitative exploration of PrEP acceptability: Questions, expectations, and concerns among adult MSM in the US

Wednesday, October 31, 2012 : 11:15 AM - 11:30 AM

Kristen Underhill, D.Phil., J.D. , Yale Law School/ Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT
Kathleen Morrow, PhD , Miriam Hospital, Brown University, Providence, RI
Don Operario, PhD , Department of Behavioral and Social Sciences, Brown University, Providence, RI
Robert Ducharme, BA , Center for AIDS Research, The Miriam Hospital, Providence, RI
Caroline Kuo, DPhil , Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University, Providence, RI
     
Background: Emerging research has identified the potential for oral pre-exposure prophylaxis to reduce HIV among men who have sex with men. Although quantitative surveys have documented willingness to use PrEP among MSM, in-depth research is necessary to understand the expectations and concerns that shape these attitudes. This formative qualitative study explored PrEP knowledge, willingness to use PrEP, and risk compensation beliefs among MSM.

Methods: Participant inclusion criteria were as follows: adult men (18+), not known to have HIV, and self-reported recent (past 6 months) unprotected anal sex with a man of HIV-positive or unknown status. Participants were recruited from metropolitan Providence, RI. Six semi-structured focus groups were planned, with 4-6 men in each. Discussions were audio-recorded, transcribed, and thematically analyzed to identify factors influencing PrEP acceptability.

Results: Preliminary findings indicate that willingness to use PrEP is complex and variable, and current PrEP knowledge is low. Participants identified potential benefits of PrEP for men at highest risk (e.g., increased intimacy, reduced anxiety), but expressed concerns about side effects, cost, insurance coverage, availability for low-income men, FDA approval, and PrEP's potential behavioral impacts on the MSM community. Efficacy was of paramount concern; some reported that they would not use PrEP without certainty of benefit. Participants also voiced apprehension that widespread use may increase sexual risk-taking.

Conclusions: A qualitative investigation of attitudes among MSM reveals important concerns that affect willingness to use PrEP and expectations about PrEP's community-level effects. Findings can inform the development of interventions to educate and support men considering PrEP.

Learning Areas:
Protection of the public in relation to communicable diseases including prevention or control
Social and behavioral sciences

Learning Objectives:
-Identify personal and contextual factors that influence willingness to use PrEP among men who have sex with men. -Describe expectations among MSM regarding the potential effects that PrEP may have on their own lives and on the MSM community. -Assess ways in which evidence from a qualitative study of PrEP acceptability may be used to develop supportive interventions for MSM considering PrEP.

Keywords: HIV/AIDS, Prevention

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: This presentation will discuss the use of antiretroviral medication as pre-exposure prophylaxis for HIV prevention. This is currently an off-label use.

Qualified on the content I am responsible for because: I am principal investigator of this study, which is funded by a K01 grant from the National Institute of Mental Health. I have a doctoral degree in Evidence-Based Social Intervention with a focus on behavioral HIV prevention, and I have completed a postdoctoral fellowship in public health. I have been researching the social aspects of PrEP for approximately 2 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5134.0: Integrated Approaches to HIV Prevention and Treatment