Reciprocal Causal Relationships in Condom- and PrEP-related Beliefs and Behavior Among Young Men Who Have Sex with Men
Open AccessEvidence of low medication adherence and engagement in condomless anal sex among young men who have sex with men (YMSM) on pre-exposure prophylaxis (PrEP) suggests continued HIV risk for this group and signals the need to understand factors related to these behaviors. Using the information-motivation-behavioral skills model and the prototype willingness model, the present longitudinal study investigated the relationships between cognitive barriers and motivations for condom use (e.g., beliefs that condoms reduce pleasure) and condomless anal sex and between PrEP-related sex expectancies (i.e., beliefs that other sexual risk reduction practices are unnecessary when using PrEP) and adherence among a sample of YMSM ages 15-22 (N=236; 60.6% racial/ethnic minority). Participants completed self-report measures of condom barriers and motivations and PrEP-related sex expectancies at baseline and week 48 and of sexual behavior at baseline and follow-ups (at weeks 4, 8, 12, 24, 36, and 48); dried blood spot measures assessed PrEP adherence at follow-ups. Findings indicated that beliefs that condoms interfere with pleasure and intimacy predicted condomless anal sex and that condomless anal sex predicted changes in subsequent pleasure- and intimacy-related beliefs. PrEP-related sex expectancies did not predict PrEP adherence, but greater likelihood of PrEP initiation predicted more positive subsequent PrEP-related sex expectancies, controlling for these expectancies at baseline. Results supported a reciprocal, mutually-reinforcing relationship between cognitive barriers to condom use and condomless anal sex among YMSM prescribed PrEP. In addition, findings suggest that YMSM taking PrEP developed stronger beliefs about the acceptability of relaxing other HIV prevention behaviors while using it.
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