Columbia Law School, Columbia University, 435 W 116th St., New York, NY, 10027, USA.
Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
Arch Sex Behav. 2018 Oct;47(7):2109-2121. doi: 10.1007/s10508-017-1100-8. Epub 2018 Jan 11.
Individual perceptions of HIV risk influence willingness to use pre-exposure prophylaxis (PrEP) for HIV prevention. Among men who have sex with men (MSM) and male sex workers (MSWs), temporal or episodic changes in risk behavior may influence perceived risk and PrEP acceptability over time. We investigated fluctuations in perceived HIV risk and PrEP acceptability, comparing MSWs against MSM who do not engage in sex work. We conducted 8 focus groups (n = 38) and 56 individual interviews among MSM and MSWs in Providence, RI. Perceived HIV risk shaped willingness to use PrEP among both MSWs and MSM who did not engage in sex work, and risk perceptions changed over time depending on behavior. For MSWs, perceived risk cycled according to patterns of substance use and sex work activity. These cycles yielded an "access-interest paradox": an inverse relationship between willingness to use and ability to access PrEP. MSM who did not engage in sex work also reported temporal shifts in risk behavior, perceived risk, and willingness to use PrEP, but changes were unrelated to access. MSM attributed fluctuations to seasonal changes, vacations, partnerships, behavioral "phases," and episodic alcohol or drug use. Efforts to implement PrEP among MSM and street-based MSWs should address temporal changes in willingness to use PrEP, which are linked to perceived risk. Among MSWs, confronting the access-interest paradox may require intensive outreach during high-risk times and efforts to address low perceived risk during times of reduced sex work.
个体对 HIV 风险的感知会影响他们使用暴露前预防（PrEP）来预防 HIV 的意愿。在男男性行为者（MSM）和男性性工作者（MSWs）中，风险行为的暂时或偶发性变化可能会随着时间的推移影响他们对风险的感知和对 PrEP 的接受程度。我们研究了感知 HIV 风险和 PrEP 可接受性的波动情况，将性工作者与不从事性工作的 MSM 进行了比较。我们在罗得岛州普罗维登斯市进行了 8 个焦点小组（n=38）和 56 个个人访谈，对象是 MSM 和 MSWs。在不从事性工作的 MSM 和 MSWs 中，感知 HIV 风险塑造了他们使用 PrEP 的意愿，并且风险感知随着时间的推移而变化，取决于行为。对于 MSWs 来说，感知风险根据物质使用和性工作活动的模式而循环变化。这些周期产生了一种“获取-兴趣悖论”：使用 PrEP 的意愿与获取 PrEP 的能力之间呈反比关系。不从事性工作的 MSM 也报告了风险行为、感知风险和使用 PrEP 的意愿的时间变化，但这些变化与获取无关。MSM 将波动归因于季节性变化、假期、伴侣关系、行为“阶段”以及偶发性的酒精或药物使用。在 MSM 和街头性工作者中实施 PrEP 的努力应该解决与感知风险相关的使用 PrEP 的意愿的时间变化。对于 MSWs 来说，要解决获取-兴趣悖论，可能需要在高风险时期进行密集的外展工作，并在性工作减少时期努力解决低感知风险的问题。
