Exploring Men who have sex with men’s HIV Pre-exposure Prophylaxis Initiation Decision-making Processes in the Southern United States

<p>In 2012, the first pharmacological HIV preventative agent, pre-exposure prophylaxis (PrEP) was approved in the U.S. for individuals at high-risk of contracting HIV. Men who have sex with men (MSM) are at increased HIV risk, due to their engagement in anal intercourse (AI), which is the most common mode of HIV transmission and the riskiest type of sex. Although evidence indicates that most PrEP paients are MSM, a paucity of evidence exists on MSM’s PrEP initation decision-making process. The purpose of this study was to explore how HIV-negative MSM engaging in protected or unprotected AI decide to initiate PrEP based on the evaluation and perceptions pertaining to their: (a) PrEP knowledge and HIV risk(s)/concern(s); (b) personal and social motivations to initiate PrEP; and (c) behavioral skills and abilities to adhere to PrEP. Guided by the Information-Motivation Behavioral (IMB) skills model, a six-item questionnaire was constructed and used to conduct one-on-one semi-structured interviews. Fourteen MSM (71% African-American) living in the Southern U.S. consented to an interview between March and August of 2018. Several themes emerged from the inductive content analysis, and these themes were categorized into five broader concepts: (1) acknowledged HIV-risks, (2) HIV concerns, (3) PrEP understanding, (4) PrEP accessibility, and (5) PrEP consideration. On further analysis, the data revealed the PrEP Initiation Decision-making (PID) model, a conceptualization of this sample’s non-linear thoughtful process of weighing and evaluating their perceptions and attitudes surrounding these five factors in deriving at their decision to initiate PrEP. The findings give insight into the PrEP initiation decision-making process of an HIV-vulnerable population. Knowledge of patients’ rationale and decision-making process for initiating PrEP allows nursing professionals to provide in-depth PrEP patient education, ensuring that patients receive accurate and complete PrEP information including the (1) relationship between adherence and efficacy; (2) utilization of traditional risk-reduction behaviors in conjunction with PrEP; and (3) the availability of financial assistance programs. This study’s evidence is foundational, establishing a knowledge base for PrEP initiation inquiries in the MSM and other PrEP patient populations in the U.S. </p>

Name thesis:degree_name

Doctor of Nursing Science (DNS)

Level thesis:degree_level

Dissertation

Discipline thesis:degree_discipline

Nursing

Year dc:date.available

2018

Author dc:creator

• Thomas, Portia

Contributors dc:contributor

• Barbara Blake, PhD, RN
• Gloria Taylor, PhD, RN
• Evelina Sterling, PhD, MPH

• HIV prevention
• MSM
• HIV pre-exposure prophylaxis
• PrEP
• decision-making
• Other Nursing
• Public Health and Community Nursing

Repository record dc:identifier

https://digitalcommons.kennesaw.edu/dns_etd/7

OAI identifier oai:identifier

oai:digitalcommons.kennesaw.edu:dns_etd-1008