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Differences between groups of pre-exposure prophylaxis (PrEP) using couples in HIV-negative/unknown relationships

John, Steven A., PhD, MPH1; Robles, Gabriel, PhD, MSW2; Starks, Tyrel J., PhD2,3,4; Rendina, H. Jonathon, PhD, MPSSSH*,2,3,4

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 11, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000002058
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Background: Epidemiology research is limited on the characteristics of HIV pre-exposure prophylaxis (PrEP) using couples.

Setting: United States nationwide sample recruited online in 2017.

Methods: HIV-negative/unknown gay, bisexual, and other men who have sex with men (GBMSM) with HIV-negative/unknown partners (n=3140) were asked about individual and main partner PrEP uptake. Men were coded into five groups: 1) neither participant nor partner on PrEP, 2) partner only on PrEP, 3) participant only on PrEP, 4) both on PrEP, and 5) unknown partner PrEP use. We examined associations of demographics, relationship factors, condomless anal sex (CAS) with main and causal partners, bacterial sexually transmitted infection (BSTI) diagnoses, and sexual positioning with reported dyadic PrEP use using fully-adjusted multinomial logistic regressions.

Results: PrEP use was 3.2% for the partner only, 5.7% for the participant only, and 4.9% for both participant and partner; 5.6% reported not knowing their partner’s PrEP use status. Men who reported any CAS with their main partner or any CAS with male casual partners were both more likely to be classified in the dyadic PrEP use group compared to the neither on PrEP group. Compared to monogamous, men in open arrangements were more likely to be classified in each of the three PrEP groups compared to the neither on PrEP group. Six-month BSTI prevalence was 2.8%, 8.1%, 8.3%, 15.6%, and 4.0% for the five groups, respectively.

Conclusions: PrEP use occurred during times of higher risk behavior engagement, but further efforts are needed to expand PrEP use to more partnered GBMSM.

1Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

2Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA

3Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA

4Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA

Author to whom correspondence should be addressed; Address: 695 Park Avenue, Room N611, New York, NY 10065; Phone: 212-206-7919; Fax: 212-206-7994; Email: hrendina@hunter.cuny.edu

Conflicts of Interest and Source of Funding: Funding: Steven A. John was supported by the Center for AIDS Intervention Research (CAIR) and the National Institute of Mental Health (P30-MH052776, PI: Jeffrey A. Kelly). Gabriel Robles received support from the National Institute on Drug Abuse (R01-DA045613-01S1, PI: Tyrel J. Starks, Awardee: Gabriel Robles). H. Jonathon Rendina was supported in part by a career development award from the National Institute on Drug Abuse (K01-DA039060; PI: H. Jonathon Rendina). Data collection for this paper was supported in part by the Fordham HIV and Drug Abuse Prevention Research Ethics Training Institute (RETI), a training grant sponsored by the National Institute on Drug Abuse (R25-DA031608, PI: Celia B. Fisher). The authors also acknowledge the generous funding provided by the offices of the President, the Provost, and the Dean of Arts & Sciences of Hunter College, CUNY; additional support was also provided by Hunter College’s Center for HIV/AIDS Educational Studies & Training (CHEST). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, Fordham RETI, Medical College of Wisconsin, or Hunter College, CUNY.

Conflict of Interest: The authors declare that they have no conflict of interest.

Previous meeting where part of these data were presented: International Association of Providers of AIDS Care (IAPAC) Conference, Miami, FL. June 8-10, 2018.

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