Effect of Pre-Exposure Prophylaxis (PrEP) Education on Sexual Behaviors of Gay and Bisexual Men

Abstract

Pre-exposure prophylaxis (PrEP) is a drug that prevents the transmission of human-immunodeficiency virus (HIV), but not the transmission of other sexually-transmitted infections (STIs). Studies of PrEP use to prevent the transmission of HIV among gay and bisexual men (GBM) have demonstrated high risks for engagement in risk-compensating sexual behaviors, which increase their susceptibility to STIs. This study’s aims were to elicit understanding of the effect of PrEP education on sexual behaviors and STI rates of GBM, and to inform the development of evidence-based PrEP education. The quasi-experimental intervention study was based on Pender’s Health Promotion Model (HPM) as the theoretical framework and comprised two phases: a pre-post intervention assessment and a three-month follow-up. The knowledge, attitudes, and practices (KAP) of a purposive sample of GBM were measured in both phases, through in-person semi-structured interviews, an STI-PrEP Knowledge QuestionnaireTM, Sexual Risk Cognition Questionnaire (SRCQ), and self-reported STI status. The intervention comprised two brief Centers for Disease Control and Prevention (CDC) educational videos. Quantitative analyses included descriptive statistics and non-parametric tests. Analysis of open-ended questions was based on the hierarchical, editing style to generate categories and themes. Eight GBM participated in the first phase and four of them (50%) in the second, follow-up phase. Comparing the STI-PrEP questionnaire scores, there was a significant difference in scores between pre-intervention (Median = 13.50) and both post-intervention (Median = 15.00) and three-month follow-up (Median = 14.75), p = .023, demonstrating that the improvement in STI-PrEP questionnaire scores was maintained at follow-up. The SRCQ yielded no significant change in sexual cognition between pre-intervention and follow-up, p = .461. There was a 25% decrease in the self-reported STI rate from baseline at pre-intervention to follow-up. Thematic analysis of the qualitative responses showed that PrEP use motivators include sexual pleasure, condom-less sex, and PrEP’s efficacy; PrEP education effects include improved informed decision-making and PrEP compliance. PrEP education improved knowledge, reduced STI rates, and had an effect on sexual intentions. Strengthened PrEP education in healthcare may improve sexual behaviors and STI rates utilizing the HPM and a multidisciplinary approach in implementing multimodal strategies in addressing sexual behaviors.