title: HIV-negative male couples' attitudes about pre-exposure prophylaxis (PrEP) and using PrEP with a sexual agreement.
abstract: One efficacious strategy to help prevent HIV is oral pre-exposure prophylaxis (PrEP), a daily regimen of antiretroviral treatment taken by HIV-negative individuals. Two of the recommendations of Centers for Disease Control and Prevention (CDC) guidelines for PrEP pertain to being in a relationship (i.e., male couples). Despite the recognition of how primary partners in male couples' relationships shape HIV risk and CDC's PrEP guidelines, there is a paucity of data that examine HIV-negative male couples' attitudes toward PrEP use and using PrEP with a sexual agreement. A sexual agreement is an explicit agreement made between two individuals about what sex and other related behaviors may occur within and outside of their relationship. In this qualitative study, we examine HIV-negative male couples' attitudes toward PrEP use and whether they thought PrEP could be integrated into a sexual agreement. Data for this study are drawn from couple-level interviews conducted in 2014 with 29 HIV-negative male couples who had a sexual agreement and were from Atlanta or Detroit. Both passive (e.g., flyers) and active (e.g., targeted Facebook advertisements) recruitment methods were used; the sample was stratified by agreement type. Thematic analysis was applied to identify the following themes regarding HIV-negative male couples' attitudes toward PrEP use: (1) PrEP and condom use; (2) concerns about PrEP (e.g., effectiveness, side effects, and promoting sexually risky behavior); and (3) accessibility of PrEP. Some thought PrEP could be a part of couples' agreement because it could help reduce sexual anxiety and sexual risk, and would help keep the couple safe. Others described PrEP use with an agreement as something for "others". Some were also concerned that incorporating PrEP could usurp the need for a sexual agreement in a couples' relationship. These themes highlight the need to improve informational messaging and promotion efforts about PrEP among HIV-negative male couples who may benefit from using it.
authors.affiliation: a Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Mitchell
authors.affiliation: a Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.
authors.forename: Ji-Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: b Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.
authors.forename: Cory
authors.initials: C
authors.lastname: Woodyatt
authors.affiliation: c Department of Health Behavior and Health Education, School of Public Health, and The Center for Sexuality and Health Disparities , University of Michigan , Ann Arbor , MI , USA.
authors.forename: José
authors.initials: J
authors.lastname: Bauermeister
authors.affiliation: b Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sullivan
authors.affiliation: d Department of Health Behavior and Biological Sciences, School of Nursing, and The Center for Sexuality and Health Disparities , University of Michigan , Ann Arbor , MI , USA.
authors.forename: Rob
authors.initials: R
authors.lastname: Stephenson
mesh_terms: D000328:Adult; D000368:Aged; D005191:Family Characteristics; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D018023:HIV Seronegativity; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D065129:Pre-Exposure Prophylaxis; D036301:Qualitative Research; D012309:Risk-Taking; D021841:Safe Sex; D012725:Sexual Behavior; D012747:Sexual Partners / Q000523:psychology*
keywords: Male couples; attitudes; dyadic data; pre-exposure prophylaxis; qualitative interviews; sexual agreements