Social-Cognitive and Identity-Related Factors Promoting Pre-exposure Prophylaxis (PrEP) Uptake Among Bisexual Men

Pre-exposure prophylaxis (PrEP) is the cornerstone of HIV prevention in the United States, yet uptake remains low among bisexual men compared to gay men. Theory-driven communication interventions have promise for addressing this disparity. Prior research among gay and bisexual men has shown that the Reasoned Action Approach (RAA) can predict PrEP intentions through attitudes, norms, and perceived behavioral control, while other studies highlight the influence of sexual identity-related stressors on prevention behaviors. However, bisexual men remain underrepresented in this work. This study sought to address this gap by exploring modifiable socio-cultural influences on bisexual men's PrEP use that can inform the development of PrEP promotion messages. Through an online survey of N = 276 US bisexual men, this study examined the relative impact of RAA factors (e.g., attitudes, perceived norms, and control beliefs) and identity-related stressors (e.g., concealment, masculine consciousness, and identity conflict) on intentions to use PrEP. The results revealed that, in contrast to previous work, only experiential attitudes toward PrEP (e.g., worry over HIV risk) were significantly associated with intentions, while instrumental attitudes, norms, and control beliefs were not. Regarding identity-related stressors, concealment from family was negatively associated with intentions, but masculine consciousness and identity conflict were not. Findings suggest that bisexual men's PrEP decisions may be shaped less by the cognitive predictors and more by affective and concealment-related processes. The results underscore the risk of generalizing findings from studies of gay men to bisexual men and highlight the need for more research to understand bisexual men's PrEP use motivations.