title: The "Safe Sex" Conundrum: Anticipated Stigma From Sexual Partners as a Barrier to PrEP Use Among Substance Using MSM Engaging in Transactional Sex.
abstract: Pre-exposure prophylaxis (PrEP) is efficacious for HIV prevention when taken consistently; however, barriers to PrEP use are poorly understood among individuals who could benefit from PrEP, including men who have sex with men (MSM) who engage in transactional sex (i.e., sex exchanged for money or drugs). Two hundred and thirty-seven HIV-uninfected, PrEP-naive MSM reporting concurrent substance dependence and sexual risk completed a questionnaire on PrEP use barriers. Barriers to PrEP use for MSM who engaged in recent transactional sex (22 %) versus those who had not were compared using an ecological framework. Individual (e.g., HIV stigma, substance use) and structural (e.g., economic, healthcare) barriers did not differ (p > 0.05). MSM who recently engaged in transactional sex were more likely to report that anticipated stigma from primary and casual partners would be barriers to PrEP use. Assessing recent transactional sex may help identify men who may need additional counseling to avoid anticipated stigma so they can integrate PrEP into their lives.
authors.affiliation: Departments of Epidemiology and Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, RI, USA. katie_biello@brown.edu.|Institute for Community Health Promotion, Brown University, Providence, RI, USA. katie_biello@brown.edu.|The Fenway Institute, Fenway Health, Boston, MA, USA. katie_biello@brown.edu.
authors.forename: Katie B
authors.initials: KB
authors.lastname: Biello
authors.affiliation: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Oldenburg
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Mitty
authors.affiliation: The Fenway Institute, Fenway Health, Boston, MA, USA.|Department of Social and Environmental Health Research, The London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Closson
authors.affiliation: The Fenway Institute, Fenway Health, Boston, MA, USA.|Division of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA.|Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.affiliation: Department of Psychology, University of Miami, Miami, FL, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.affiliation: Departments of Epidemiology and Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.|Institute for Community Health Promotion, Brown University, Providence, RI, USA.|The Fenway Institute, Fenway Health, Boston, MA, USA.|Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mimiaga
mesh_terms: D000328:Adult; D001727:Bisexuality; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D065129:Pre-Exposure Prophylaxis; D021841:Safe Sex; D011477:Sex Work; D012725:Sexual Behavior; D012747:Sexual Partners; D000072339:Sexual and Gender Minorities; D057545:Social Stigma; D019966:Substance-Related Disorders; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: HIV; Men who have sex with men; Pre-exposure prophylaxis; Prevention