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Low Self-Perceived Need for PrEP and Behavioral Indications of MSM Who Recently Refused Daily PrEP: A Mixed Methods

Krishna Kiran Kota1,2, Deborah Gelaude3, Neal Carnes3

  • 1Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS H18-3, Atlanta, GA, USA. qel3@cdc.gov.

AIDS and Behavior
|March 8, 2024
PubMed

Insights

Many gay, bisexual, and other men who have sex with men (MSM) decline pre-exposure prophylaxis (PrEP) due to low perceived HIV risk and high confidence in other prevention methods. Continued provider discussion of PrEP benefits is recommended.

Area of Science:

  • Public Health
  • Epidemiology
  • Behavioral Science

Background:

  • Pre-exposure prophylaxis (PrEP) is highly effective in reducing HIV transmission risk among men who have sex with men (MSM).
  • Underutilization of PrEP persists within the MSM community, necessitating an understanding of refusal reasons.
  • Low self-perceived need is a significant barrier to PrEP uptake among MSM.

Purpose of the Study:

  • To investigate the reasons for PrEP refusal among MSM who perceive a low need for it.
  • To identify specific prevention strategies that contribute to a low self-perceived need for PrEP in this population.

Main Methods:

  • A mixed-method study combining quantitative surveys (N=93) and qualitative interviews/focus groups (n=93) with MSM in Atlanta, Chicago, and Raleigh-Durham.
  • Participants had recently declined daily oral PrEP when offered by a healthcare provider.
  • Data analysis focused on identifying themes related to low self-perceived need for PrEP.

Main Results:

  • Key reasons for low self-perceived need included low perceived HIV risk (33%), confidence in remaining HIV-negative (35%), and reliance on other prevention methods.
  • Other cited strategies included condom use (81%), limiting partners (48%), partner HIV status disclosure (45%), safer sex practices (28%), monogamy (26%), and regular HIV testing (18%).
  • Low perceived risk and confidence in alternative prevention strategies were primary drivers for PrEP refusal.

Conclusions:

  • Low self-perceived risk and high confidence in existing prevention methods significantly contribute to MSM refusing PrEP.
  • Healthcare providers should proactively address these perceptions and continue educating MSM about PrEP's benefits.
  • Further research may explore tailored interventions to improve PrEP uptake among MSM with low perceived need.
Keywords:
Confidence in condom useHIV prevention strategiesPerceived HIV risk

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