title: Condom-use decision making in the context of hypothetical pre-exposure prophylaxis efficacy among substance-using men who have sex with men: Project MIX.
abstract: OBJECTIVE
  To examine condom-use decision making in the context of hypothetical pre-exposure prophylaxsis (PrEP) efficacy among men who have sex with men who use alcohol and other substances during sex.
  
  
  METHODS
  Substance-using men who have sex with men were recruited in 4 US cities for a behavioral intervention trial. Three groups were defined as follows: men who indicated that to not use a condom for receptive/insertive unprotected anal intercourse (UAI) while using PrEP, PrEP would need to be: (1) "almost always or always" effective (high efficacy); (2) effective "at least half the time or more but not almost always or always" (mid-range efficacy corresponding to recent PrEP trial results); (3) effective "less than half the time" (low efficacy). The mid-range efficacy group was compared with the low-efficacy group (as the reference) and to the-high efficacy group (as the reference).
  
  
  RESULTS
  Among 630 men who never used PrEP, 15.2% were in the mid-range efficacy group for receptive UAI and 34.1% in the mid-range efficacy group for insertive UAI. Scores on difficulty communicating about safer sex while high were significantly higher in the mid-range efficacy group compared with each of the other groups for both receptive and insertive UAI. Men who seemed to be differentiating PrEP use by anal sex role also scored higher on communication difficulties, although scoring lower on condom intentions.
  
  
  CONCLUSIONS
  Communication about safer sex while under the influence of alcohol or other substances and condom intentions are important factors to consider for HIV prevention interventions for PrEP users.
authors.affiliation: Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY 10065, USA. bkoblin@nybloodcenter.org
authors.forename: Beryl A
authors.initials: BA
authors.lastname: Koblin
authors.forename: Gordon
authors.initials: G
authors.lastname: Mansergh
authors.forename: Victoria
authors.initials: V
authors.lastname: Frye
authors.forename: Hong Van
authors.initials: HV
authors.lastname: Tieu
authors.forename: Donald R
authors.initials: DR
authors.lastname: Hoover
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bonner
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Flores
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Hudson
authors.forename: Grant N
authors.initials: GN
authors.lastname: Colfax
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017280:Condoms / Q000706:statistics & numerical data; D003657:Decision Making; D055030:Drug Users; D004493:Education / Q000379:methods; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D021841:Safe Sex / Q000523:psychology*; D014481:United States; D055815:Young Adult