Drawing from the Theory of Planned Behaviour to examine pre-exposure prophylaxis uptake intentions among heterosexuals in high HIV prevalence neighbourhoods in Philadelphia, Pennsylvania, USA: an observational study
Alexis Roth A E , Marisa Felsher
A , Nguyen Tran B , Scarlett Bellamy B , Ana Martinez-Donate A , Douglas Krakower C and Zsofia Szep D
+ Author Affiliations
- Author Affiliations
A Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA.
B Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA.
C Division of Infectious Disease, Beth Israel Deaconess Medical Center, 110 Francis Street, Lowry GB, Boston, MA 02215-5501, USA.
D Division of Infectious Diseases and HIV Medicine, College of Medicine, Drexel University, 245 N 15th Street, Philadelphia, PA 19102, USA.
E Corresponding author. Email: alexisroth@drexel.edu
Sexual Health 16(3) 218-224 https://doi.org/10.1071/SH18081
Submitted: 8 May 2018 Accepted: 19 December 2018 Published: 13 May 2019
Abstract
Background: Research surrounding attitudes and intentions concerning pre-exposure prophylaxis (PrEP) among at-risk heterosexuals, women and ethnic and racial minorities is needed to inform programs to scale this effective HIV prevention intervention among these populations. Methods: The study sample includes 192 HIV-negative heterosexuals recruited from HIV testing sites operating in high HIV prevalence neighbourhoods in a mid-Atlantic city. Participants received brief educational sessions on PrEP and completed a self-administered survey assessing sociodemographic factors, HIV risk behaviours and theoretical determinants of PrEP uptake, based on the Theory of Planned Behaviour. Results: Participants were majority persons of colour (86%), with a median age of 43 years. Compared with Whites, a higher percentage of Black and Brown persons had more than five sex partners (75.0%), used condoms inconsistently (85.6%) and engaged in transactional sex (84.4%). Most expressed positive PrEP attitudes and indicated intention to adopt PrEP, especially if recommended by their doctor. In a multivariable model, willingness to take PrEP if suggested by a healthcare provider (aOR: 4.17; 95% CI: 1.42–12.24) and willingness to take PrEP even if it caused side-effects (aOR: 1.98; 95% CI: 1.01–3.90) were both associated with greater PrEP adoption intentions. Conclusions: A diverse at-risk population was identified through community-based HIV testing. Low perceived HIV risk, as well as PrEP-related attitudes, subjective norms and perceived behavioural control were associated with PrEP use intentions. These factors are potential targets for interventions to increase PrEP adoption among diverse heterosexual samples.
Additional keywords: infectious disease, PrEP, prevention.
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