Hierarchical influences on PrEP use, willingness and readiness among male couples?The incidence of HIV continues to increase among men who have sex with men (MSM) continues to increase.Moreover, between one- and two-thirds of MSM in the US acquire HIV from their main partners while in arelationship (i.e., male couples). Although a growing interest in male couples' relationships has emerged in HIVprevention research, few studies have been conducted about their attitudes, support, current use andunsuccessful attempts of obtaining of pre-exposure prophylaxis (PrEP). PrEP ? a daily regimen of ART (i.e.,Truvada?) taken by those who are HIV-negative to prevent the acquisition of HIV ? is a promising biomedicalapproach to preventing new HIV infections among MSM and male couples alike. To date, most research studieshave investigated how individual-level factors are associated with MSM's attitudes to use PrEP. Currently, twoof CDC's three guidelines for administering PrEP pertain to those who are in a relationship yet very few studieshave explored men's perceptions of how casual and main partners affect their PrEP uptake and even fewerstudies have collected data from both men of the couple. Beyond the dyadic level of being in a relationship,there is the potential for community and social network factors to shape PrEP attitudes, support, and uptake,but these influences are also largely currently under-explored. To respond to this critical gap in understandinghow relational/dyadic, community and social network factors affect PrEP uptake among male couples, wepropose to conduct a novel two-year mixed method project to collect in-person, quantitative dyadic data from100 self-reported HIV-negative and 100 self-reported HIV-discordant male couples in Miami, FL and Detroit,MI. From this sample of 200 dyads, a subsample of participants and their main partner (~N=40 dyads/n=80men) will be interviewed, individually and simultaneously, about their unsuccessful attempts to obtain PrEPand the factors associated with these unsuccessful attempts. Our purposive English or Spanish speakingsample will be drawn from targeted electronic advertisements on a range of social media used by MSM. Theadvertisements will reflect the diversity of the MSM populations in these two cities and who are most severelyimpacted by HIV (e.g., Black and Hispanic MSM, younger MSM). To address how different levels of factorsmay impact PrEP uptake among male couples, our study will be guided by Bronfenbrenner's Ecological Modelpaired with advanced analytic methods. Our project's overall aim is to examine how individual, dyadic, socialnetwork and community factors shape support, willingness, current use, and unsuccessful attempts to adoptPrEP among a diverse sample of 100 concordantly HIV-negative and 100 HIV-discordant male couples fromtwo U.S. cities that lack substantial PrEP resources. The proposed findings will highlight which hierarchalfactors and actor-partner effects reinforce PrEP support, willingness, current use, and unsuccessful attemptsamong at-risk male couples. Findings from this novel, efficient study will help inform the development ofeffective PrEP messaging for male couples and will also shape the development of future dyadic interventions.
Although a growing interest in male couples' relationships has emerged in HIV prevention research; fewstudies have been conducted about their attitudes; support; use; and unsuccessful attempts to obtain pre-exposure prophylaxis (PrEP). To respond to this critical gap in understanding which factors affect PrEP uptakeamong this vulnerable population; we propose to conduct a novel two-year mixed method project to collectdyadic data (in person) from 100 self-reported HIV-negative and 100 self-reported HIV-discordant malecouples in Miami; FL and Detroit; MI; a subsample of men and their partners (N=40 / n=80 men) will beinterviewed; individually and separately; about their unsuccessful attempts to obtain PrEP. Our innovativestudy will be guided by Bronfenbrenner's Ecological Model paired with advanced methods to examine howindividual; dyadic; social network and community factors shape support; willingness to adopt; current use; andunsuccessful attempts to obtain PrEP among an at-risk sample of concordantly HIV-negative and discordantmale couples.
