Psychosocial Profiles of Men Who Have Sex with Men (MSM) Influencing PrEP Acceptability: A Latent Profile Analysis.

Abstract

Despite the availability of pre-exposure prophylaxis (PrEP) in the United Kingdom (UK), uptake among men who have sex with men (MSM) remains inconsistent, signalling a persistent 'PrEP Gap'. Empirical studies show the important role of psychosocial factors (e.g., stigma, identity, trust in science, and sexual behaviours) in PrEP acceptability and uptake. This study aimed to identify subgroups of MSM in the UK based on psychosocial predictors of PrEP acceptability. A cross-sectional survey of MSM (N = 500) was conducted between June and September 2023. Participants completed validated measures assessing identity resilience, internalised homonegativity, LGBTQ+ connectedness, trust in science, NHS perceptions, HIV stigma, PrEP self-efficacy, condom self-efficacy, sociosexual orientation, perceived HIV risk, and PrEP acceptability. Latent Profile Analysis (LPA) was used to identify distinct subgroups based on these psychosocial dimensions. Four psychosocial profiles were defined: (1) PrEP Ambivalent (15%); (2) PrEP Accepting (36.2%); (3) PrEP Hesitant (37%); and (4) PrEP Rejecting (11.8%). These profiles provide evidence for varied combinations of personal and structural factors influencing PrEP acceptability. PrEP acceptability among MSM in the UK is shaped by distinct psychosocial configurations, influenced by identity, stigma, trust, and perceived risk. These findings highlight the need for differentiated and targeted interventions for enhancing PrEP acceptability based on psychosocial profile. Audience segmentation strategies offer a promising pathway to bridge the awareness-to-engagement gap and address the nuanced barriers facing diverse subgroups within the MSM community.