Distinguishing hypothetical willingness from behavioral intentions to initiate HIV pre-exposure prophylaxis (PrEP): Findings from a large cohort of gay and bisexual men in the U.S. (January 2017)

• Record Type: Journal Article
• Authors: Rendina, H. Jonathon; Whitfield, Thomas H.F.; Grov, Christian; Starks, Tyrel J.; Parsons, Jeffrey T.
• Is Part Of: Social science & medicine. Volume 172(2017)
• Page Start: 115
• Page End: 123
• Publication Date: 2017-01
• Subjects: Pre-exposure prophylaxis -- PrEP -- Gay and bisexual men -- HIV prevention -- Behavioral intentions -- Uptake; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2016.10.030
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Rationale: Much of the data on the acceptability of HIV Pre-Exposure Prophylaxis (PrEP) is based on willingness to take PrEP (i.e., hypothetical receptivity) rather than actual intentions (i.e., planned behavioral action) to do so. Objective: We sought to examine differences between hypothetical willingness and behavioral intentions to begin PrEP in a national sample of gay and bisexual men (GBM) across the U.S. Methods: We utilized data collected in 2015 to examine differences between those Unwilling (42.6% n = 375), Willing but not intending (41.4%, n = 365), and willing and Intending to take PrEP (15.9%, n = 140) in a multivariable, multinomial logistic regression. Results: Men with less education had higher odds of Intending to take PrEP. Compared to men unsure about PrEP's efficacy, those who believed PrEP was at least 90% efficacious had higher odds of Intending to take PrEP. Those who saw themselves as appropriate candidates for PrEP had higher odds of Intending to take PrEP while those who saw themselves as inappropriate candidates for PrEP had lower odds of Intending to take PrEP in comparison to men unsure if they were appropriate candidates. Increased motivation for condom non-use because of perceived sexual pressure by partners was associated with higher odds of Intending to take PrEP. The groups did not differ by risk behavior nor recent STI diagnosis. Conclusions: Overall, the distinction between willingness and intentions to take PrEP was meaningful and may help explain disparities between PrEP acceptability and uptake. While much of the literature has focused on hypothetical willingness to take PrEP, these results highlight the importance of simultaneously assessing willingness and intentions when examining correspondence with uptake and developing interventions to increase PrEP uptake. Highlights: We compared hypothetical willingness and behavioral intentions to take PrEP. Many more men were hypothetically willing to take PrEP than intended to take it. Intending to begin PrEP was most common among men most at risk for HIV. Paradoxically, men intending to begin PrEP were those with the least access to it. The willingness-intentions discrepancy may help explain low rates of PrEP uptake.