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The "Safe Sex" Conundrum: Anticipated Stigma From Sexual Partners as a Barrier to PrEP Use Among Substance Using MSM Engaging in Transactional Sex.

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      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.

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      Affiliations
      [1 ] Departments of Epidemiology and Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, RI, USA. katie_biello@brown.edu.
      [2 ] Institute for Community Health Promotion, Brown University, Providence, RI, USA. katie_biello@brown.edu.
      [3 ] The Fenway Institute, Fenway Health, Boston, MA, USA. katie_biello@brown.edu.
      [4 ] Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
      [5 ] Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
      [6 ] The Fenway Institute, Fenway Health, Boston, MA, USA.
      [7 ] Department of Social and Environmental Health Research, The London School of Hygiene & Tropical Medicine, London, UK.
      [8 ] Division of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA.
      [9 ] Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
      [10 ] Department of Psychology, University of Miami, Miami, FL, USA.
      [11 ] Departments of Epidemiology and Behavioral & Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.
      [12 ] Institute for Community Health Promotion, Brown University, Providence, RI, USA.
      Journal
      AIDS Behav
      AIDS and behavior
      Springer Nature
      1573-3254
      1090-7165
      Jan 2017
      : 21
      : 1
      27351194 10.1007/s10461-016-1466-y 10.1007/s10461-016-1466-y

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