Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St., Box G-S121-3, Providence, RI, 02912, USA.
Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA.
Arch Sex Behav. 2024 Apr;53(4):1541-1559. doi: 10.1007/s10508-024-02822-8. Epub 2024 Mar 12.
Pre-exposure prophylaxis (PrEP) use may be associated with condom use decisions. The current investigation examined sexual decision-making in the context of PrEP among young adult men who have sex with men (MSM) between 18 and 30 years old, using an explanatory sequential mixed methods design. For the quantitative aim, 99 MSM currently taking PrEP (i.e., PrEP-experienced) and 140 MSM not currently taking PrEP (i.e., PrEP-naive) completed an online survey, including the Sexual Delay Discounting Task (SDDT), which captures likelihood of condom use. For the qualitative aim, 15 people from each group were interviewed about their (1) conceptualizations of risky sex and (2) ways they manage their sexual risk. Participants were, on average, 25.69 years old (SD = 3.07) and 64% White. Results from the quantitative aim revealed, controlling for covariates, PrEP-experienced participants exhibited significantly lower likelihood of (1) using an immediately available condom and (2) waiting for a delayed condom (i.e., sexual delay discounting) compared to PrEP-naive participants. Qualitative themes explaining what young adult MSM consider to be risky sex included: (1) any sex as risky sex, (2) risky sex as "sex without a conversation," and (3) risky sex as sex with risk for physical harm. Themes on ways young adult MSM manage sexual risk were classified as proactive, reactive, and passive. Results suggest that PrEP use is related to condom use decisions. Taken together, quantitative differences in sexual delay discounting, but qualitatively similar conceptualizations and management of risky sex, suggest that the SDDT may be a useful tool in sex research to capture processes (i.e., delay discounting) underlying sexual decision-making that may be missed by traditional self-reports. Implications of results, including potentially providing (good quality) condoms with every PrEP prescription, and future research topics are discussed.
暴露前预防（PrEP）的使用可能与 condom 的使用决策有关。本研究采用解释性顺序混合方法设计，调查了 18 至 30 岁之间有男男性行为的年轻男性（MSM）在 PrEP 背景下的性决策。对于定量目标，99 名正在服用 PrEP 的 MSM（即 PrEP 经验者）和 140 名未服用 PrEP 的 MSM（即 PrEP 未经验者）完成了一项在线调查，包括性延迟折扣任务（SDDT），该任务可捕捉 condom 的使用可能性。对于定性目标，从每个组中随机抽取 15 人，分别对他们的（1）性行为风险的概念化和（2）管理性风险的方式进行访谈。参与者的平均年龄为 25.69 岁（SD=3.07），64%为白人。定量目标的结果显示，控制了协变量后，与 PrEP 未经验者相比，PrEP 经验者使用（1）立即可用 condom 的可能性和（2）等待延迟 condom（即性延迟折扣）的可能性显著降低。年轻 MSM 认为危险性行为的定性主题包括：（1）任何性行为都是危险的，（2）没有对话的性行为是危险的，（3）有身体伤害风险的性行为是危险的。年轻 MSM 管理性行为风险的主题分为主动、被动和被动。结果表明，PrEP 的使用与 condom 的使用决策有关。总的来说，性行为延迟折扣的定量差异，以及对危险性行为的定性概念和管理的差异，表明 SDDT 可能是性研究中捕捉潜在性行为决策过程（即延迟折扣）的有用工具，而这些过程可能会被传统的自我报告所忽视。讨论了结果的意义，包括可能在每一个 PrEP 处方中提供（高质量） condom，以及未来的研究主题。
