'I want him to get on PrEP': the perspectives of men who have sex with men living with HIV on sexual partners' use of pre-exposure prophylaxis.

Abstract

Background: Despite its high efficacy for HIV prevention, uptake of pre-exposure prophylaxis (PrEP) is low in the US. This is particularly concerning for men have sex with men (MSM), as they are disproportionately affected by HIV. Interpersonal factors, especially the perspectives of sexual partners living with HIV, influence the use of PrEP for MSM without HIV. Therefore, understanding how MSM with HIV (MSMWH) perceive their HIV-negative sexual partners' use of PrEP can have important implications for HIV prevention efforts. The present study sought to understand MSMWH's attitudes about and outcome expectancies of their sexual partners' PrEP use.

Methods: Semi-structured qualitative interviews were conducted with 30 MSMWH in South Carolina, US, focused on perceptions of PrEP use for their HIV-negative partners. Interviews were recorded and transcribed verbatim. An inductive, interpretive, conventional content analysis approach with two coders was used.

Results: Overall, most participants viewed PrEP positively as an option for their HIV-negative partners. Reasons for these perceptions included that their partners' PrEP use would enhance sexual security, minimize uncertainty and strengthen relationships. Primary hesitancies about HIV-negative partners' use of PrEP included concerns around side-effects, distrust due to the Truvada lawsuit, and continued sexually transmitted infection and HIV risks.

Conclusions: The present study highlights the nuanced perspectives of MSMWH on the use of PrEP for HIV-negative partners. Efforts to increase uptake of PrEP may benefit from attending to interpersonal facilitators of PrEP uptake, such as partner support.