Intimacy, Condom Use, and Pre-Exposure Prophylaxis (PrEP) Acceptability among Men Who Have Sex with Men (MSM) in Primary Partnerships: a Comment on Gamarel and Golub

摘要: As evidence grows for the effectiveness of antiretroviral pre-exposure prophylaxis (PrEP) HIV prevention (1–6), complementary research on PrEP acceptability (7) and uptake (8–13) has gained prominence. In US, largely focused men who have sex with (MSM) (14), given sustained burden incidence in this group (15). Although work identified many individual factors associated willingness to use PrEP, emerging also examined light MSM partnership dynamics (16–19). Focusing dyads is imperative: at least one-third infections among US occur within primary partnerships (20, 21), relationship dynamics—including intimacy, commitment, other interpersonal factors—demonstrably influence both risk protective behaviors (22, 23). For example, prior studies report that engage condomless express condom nonuse may be motivated by desire preserve these intimacy benefits (24–27). In issue, Gamarel Golub examine how motivations affect romantic (28). The team interviewed self-reported being seroconcordant, HIV-negative partnerships; 90% reported recent anal their partners, 34% did so an outside (non-primary) partner. Regardless whether participants had partner, were significantly positively intention if available no cost. This association was absent a separate sample without indicating through play unique role relationships. Gamarel Golub’s insightful several implications further research. First, PrEP-protected condom-protected carry different meanings partnerships, should distinctions. Study expressed concern about intimacy-inhibiting effects condoms more likely want suggesting not same way. Identifying values couples place exclusively sex, dually protected (using condoms), protection can help inform outreach, education, user support. perceived opportunity lower motivate uptake, as suggested study serodiscordant (19). Further needed, however, understand attitudes toward will behavior relationships. Second, focus brings attention potential “secondary” PrEP—namely, advantages beyond pure risk-reduction. From user’s perspective, include opportunities reduce while retaining (e.g., pleasure, fertility); reduced HIV-related anxiety or fear (19, 29–32); increased control over sexual health (31). Additional now needed users anticipate experience secondary (if all), incorporate information into support strategies. Third, findings highlight need couples-based approaches implementation MSM. Partners source adherence (16, 18, 33), but little investigated strategies 34). One tested strategy promote medication (35), which adaptable use. Several show promise (36, 37); extend dyadic interventions decision-making, well choose adopt PrEP. Finally, team’s emphasis seroconcordant meaningful expansion literature. To advance work, future might investigate acceptability, experiences context agreements shared decision-making. Intimacy one (23), features duration, communication, trust) acceptability. could explore facilitators barriers use; if, agreement prohibits partnership, viewed violation, thereby complicating adherence. reinforce providers ask patients partners when evaluating are “substantial acquisition” (38), particularly relationship. PrEP offers compelling new tool populations, including infection, efforts benefit from nuanced understanding contexts occur. such context. By identifying population, introduced important set questions, promising maximizing PrEP’s preventive impact.