Study: Gay & Bisexual Men Persuading Partners to Take PrEP
Are gay and bisexual men (GBM) likely to convince their partners to begin PrEP? This question is part of a new nationwide study on sexual health attitudes and behaviors.
The recent study, published on June 20 in AIDS and Behavior, used data from a larger study called One Thousand Strong, which followed the behaviors and health outcomes of more than 1.000 HIV-negative men over three years. Given that several prior studies have noted partner influence on health behaviors, including diet, exercise and smoking, researchers sought to investigate how gay and bisexual men exert social control over their partners’ PrEP uptake. Sex within main partnerships, after all, gives rise to approximately one half of all new HIV infections, so GBM have a good reason to be involved in the sexual health of their partners.
Researchers focused on couples in which both partners were HIV-negative and had never taken PrEP. Their results suggest that relationship status – whether GBM are in a monogamous, “monogamish” or open relationship – strongly predicts their attitude about the importance of partner PrEP use and willingness to persuade their partner to begin PrEP. Men in monogamous relationships were significantly less likely both to think that PrEP is important for their partners and to be willing to convince their partner to use PrEP compared to men in monogamish and open relationships.
Popularized by sex advice columnist Dan Savage, the term monogamish refers to the relationship arrangement wherein sex with outside partners is limited to situations when both primary partners are present. This arrangement is contrasted by open relationships, wherein primary partners can have sex with outside partners independently.
Participants in the study reported that their partner taking PrEP was only modestly important to them. Namely, on a scale from 1 (not important) to 4 (very important), the average response to the question, “How important would it be for your partner to take PrEP?” was 1.9. Men in the South were more likely to think that PrEP was important for their partners than those of any other geographic region in the U.S. White men, by contrast, were the least likely to think that PrEP was important for their partners compared to men of all other racial groups.
Similar to the results about the importance of partner PrEP, the study found that men were only modestly willing to convince their partner to use PrEP. On a scale from 1 (“I would definitely not try”) to 5 (“I would definitely try”), men’s average response to the question, “How likely would you be to try to convince him to consider starting PrEP,” was 2.4. Interestingly, older men and those with college degrees were significantly less willing to persuade their partner to use PrEP. In keeping with this trend, men who had been in relationships for a longer period of time were less willing to initiate conversations with their partner about PrEP.
Taken together, these results suggest that partner influence on PrEP uptake was not as important as personal willingness and intentions to use PrEP. As such, programs seeking to increase the PrEP uptake among GBM should target the individual directly rather than through his partner.
The study’s first author, Steven A. John, is a Postdoctoral Fellow at the Hunter College Center for HIV Educational Studies and Training (CHEST). John noted that the results of this study have direct implications on how public health professionals design programs to increase the utilization of PrEP among GBM.
“We found personal perceptions about pre-exposure prophylaxis (PrEP) to be the strongest indicators of PrEP outcomes among gay and bisexual men currently in relationships,” said John. “This means public health programs aiming to increase PrEP uptake by increasing positive perceptions of its use might translate into gay and bisexual men finding PrEP use more important for their partners and then being more willing to try to convince their partners to use it.”
John pointed out that all of the men in this analysis were HIV-negative with HIV-negative main partners. HIV-positive GBM might have different perceptions of PrEP use for their partners compared to those who participated in this study.
Without regard to PrEP, there are other important HIV prevention interventions that can involve both members of the relationship.
“Programs such as couples’ HIV testing and counseling (CHTC)—in particular—are very important for partnered gay and bisexual men, especially since CHTC can help couples reassess their risk for HIV and other sexually transmitted infections based on each of their behaviors together,” noted John.
Dr. John and his colleagues plan to conduct future research on how increasing individual perceptions of PrEP may lead to greater PrEP uptake by both individuals and their partners.