title: Ambiguity, ambivalence, and apprehensions of taking HIV-1 pre-exposure prophylaxis among male couples in San Francisco: a mixed methods study.
abstract: OBJECTIVE
  We conducted a mixed-methods study to examine serodiscordant and seroconcordant (HIV-positive/HIV-positive) male couples' PrEP awareness, concerns regarding health care providers offering PrEP to the community, and correlates of PrEP uptake by the HIV-negative member of the couple.
  
  
  METHODS
  Qualitative sub-study included one-on-one interviews to gain a deeper understanding of participants' awareness of and experiences with PrEP and concerns regarding health care providers offering PrEP to men who have sex with men (MSM). Quantitative analyses consisted of a cross-sectional study in which participants were asked about the likelihood of PrEP uptake by the HIV-negative member of the couple and level of agreement with health care providers offering PrEP to anyone requesting it.
  
  
  METHODS
  We used multivariable regression to examine associations between PrEP questions and covariates of interest and employed an inductive approach to identify key qualitative themes.
  
  
  RESULTS
  Among 328 men (164 couples), 62% had heard about PrEP, but approximately one-quarter were mistaking it with post-exposure prophylaxis. The majority of participants had low endorsement of PrEP uptake and 40% were uncertain if health care providers should offer PrEP to anyone requesting it. Qualitative interviews with 32 men suggest that this uncertainty likely stems from concerns regarding increased risk compensation. Likelihood of future PrEP uptake by the HIV-negative member of the couple was positively associated with unprotected insertive anal intercourse but negatively correlated with unprotected receptive anal intercourse.
  
  
  CONCLUSIONS
  Findings suggest that those at greatest risk may not be receptive of PrEP. Those who engage in moderate risk express more interest in PrEP; however, many voice concerns of increased risk behavior in tandem with PrEP use. Results indicate a need for further education of MSM communities and the need to determine appropriate populations in which PrEP can have the highest impact.
authors.affiliation: University of California San Francisco, San Francisco, California, United States of America. parya.saberi@ucsf.edu
authors.forename: Parya
authors.initials: P
authors.lastname: Saberi
authors.forename: Kristi E
authors.initials: KE
authors.lastname: Gamarel
authors.forename: Torsten B
authors.initials: TB
authors.lastname: Neilands
authors.forename: Megan
authors.initials: M
authors.lastname: Comfort
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sheon
authors.forename: Lynae A
authors.initials: LA
authors.lastname: Darbes
authors.forename: Mallory O
authors.initials: MO
authors.lastname: Johnson
mesh_terms: D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000523:psychology; D015497:HIV-1; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011322:Primary Prevention / Q000379:methods*; D012044:Regression Analysis; D012495:San Francisco