Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
Value Health. 2021 May;24(5):714-723. doi: 10.1016/j.jval.2020.11.023. Epub 2021 Mar 22.
We considered how decision making around human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among gay, bisexual, and other men who have sex with men (GBMSM) is made in the context of one's perceived risk of HIV acquisition and the availability of condoms.
We recruited 648 GBMSM aged 18 years old and residing in Singapore through Grindr. Participants were given information on PrEP and participated in a discrete choice experiment requiring them to choose between 2 baskets of PrEP attributes and compare the chosen "PrEP only" option to default options of "condoms only" or "PrEP with condoms." Generalized multinomial logit model was used to examine the scaling effect and preference heterogeneity. Latent class analysis was conducted to examine preference heterogeneity in the sample.
Latent class analysis revealed 3 classes of GBMSM: PrEP conservatives (53.9%), moderates (31.1%), and liberals (14.9%). PrEP conservatives were more likely to report greater utility when using condoms only compared with PrEP only, as well as PrEP with condoms, compared with PrEP only, and more likely to report the lowest utility for PrEP as perceived HIV risk increased. PrEP liberals were more likely to report greatest utilities for PrEP only compared with condoms only, as well as PrEP only compared with PrEP with condoms. The utility for PrEP was not affected by perceived risk of HIV or sexually transmitted infections when risks were low.
This study provides some evidence for risk compensation among a class of GBMSM who already perceived themselves to be good candidates for PrEP before the discrete choice experiment.
我们考虑了在考虑艾滋病毒（HIV）暴露前预防（PrEP）时，同性恋、双性恋和其他与男性发生性关系的男性（GBMSM）如何根据自身对 HIV 感染的感知风险和避孕套的可用性做出决策。
我们通过 Grindr 招募了 648 名年龄在 18 岁及以上、居住在新加坡的 GBMSM。参与者获得了关于 PrEP 的信息，并参与了离散选择实验，要求他们在两个 PrEP 属性篮子之间进行选择，并将选择的“仅 PrEP”选项与“仅避孕套”或“PrEP 与避孕套”的默认选项进行比较。使用广义多项逻辑回归模型检查了规模效应和偏好异质性。进行潜在类别分析以检查样本中的偏好异质性。
潜在类别分析显示，GBMSM 有 3 类：PrEP 保守派（53.9%）、温和派（31.1%）和自由派（14.9%）。与仅使用 PrEP 相比，PrEP 保守派更有可能报告仅使用避孕套时的更高效用，以及 PrEP 与避孕套一起使用时的更高效用，并且当感知到的 HIV 风险增加时，更有可能报告 PrEP 的最低效用。与仅使用避孕套相比，PrEP 自由派更有可能报告仅使用 PrEP 的最大效用，以及仅使用 PrEP 与 PrEP 与避孕套相比。当风险较低时，PrEP 的效用不受 HIV 或性传播感染感知风险的影响。
本研究为一类已经认为自己是 PrEP 的良好候选者的 GBMSM 在离散选择实验之前提供了一些风险补偿的证据。
