Relationship motivations for pre-exposure prophylaxis (PrEP) among HIV-negative MSM in seroconcordant negative romantic relationships

Background:  Despite increasing evidence that relationship motivations, such as desires for closeness and intimacy, are associated with sexual risk behavior, little research has examined how they may influence PrEP acceptability among HIV-negative MSM in seroconcordant negative relationships. The current study examined the degree to which intimacy motivations for condomless sex and desiring more closeness with one's partner were associated with PrEP acceptability.

Methods: As part of a larger NIH-funded study, analyses were conducted among a subsample of MSM in seroconcordant negative romantic relationships (N = 164). Participants mean age was 32.14; 60.8% were racial/ethnic minority; 62.7% earned less than $20,000 annually; 70.6% reported having an open sexual agreement. Logistic regression models examined associations between intimacy motivations for condomless sex and discrepancies between actual and desired levels of closeness with participants' reports of PrEP acceptability, adjusting for income, relationship length, sexual agreements, risk perception, and sexual risk behavior.

Results: Overall, 52.9% of participants indicating they would definitely use PrEP. There were no bivariate differences in PrEP acceptability by sexual agreement, age, race, income, education, sexual behavior, or risk perception. Intimacy motivations (aOR=1.63, 95%CI: 1.06, 2.52) and desiring more closeness were associated with PrEP acceptability (aOR=3.13; 95% CI = 1.08, 4.22). No other variables were associated with PrEP acceptability.

Conclusions: PrEP adoption may be driven by discrepancies in couples' desired levels of intimacy and closeness. Discrepancies in closeness have been shown to result in distrust and dissatisfaction. Incorporating relationship dynamics into biomedical strategies is a promising avenue for research and intervention.