AIDS and Behavior

, Volume 23, Issue 7, pp 1917–1924 | Cite as

Predictors of PrEP Uptake Among Patients with Equivalent Access

  • Sarit A. GolubEmail author
  • Rachel A. Fikslin
  • Matthew H. Goldberg
  • Stephanie M. Peña
  • Asa Radix
Original Paper


Increasing PrEP adoption for eligible individuals is critical, but limited research has examined individual-level factors that might be amenable to educational or behavioral intervention. Using data from a PrEP demonstration project conducted at a community health center, we examined differences in behavioral and psychosocial factors between patients offered PrEP who chose to accept it and those who declined. In a multivariable model, the odds of accepting PrEP were higher among those with an HIV-positive main partner, greater risk behavior in the past 3 months, and higher HIV risk perception. PrEP adoption was positively associated with PrEP adherence self-efficacy and negatively associated with perceived sensitivity to medicines. These psychological variables were associated with measures of PrEP- and HIV-related stigma. In the multivariable model, there were no differences in PrEP adoption by demographic factors or socioeconomic status. Data suggest that patients’ decisions about PrEP uptake may be impacted not only by objective and subjective HIV risk, but also by psychological variables such as stigma beliefs, medication beliefs, and self-efficacy.


Pre-exposure prophylaxis (PrEP) HIV prevention Implementation Stigma Self-efficacy 



This research was funded by Grant R01AA022067 from the National Institute of Alcohol Abuse and Alcoholism (S.A. Golub, PI). We gratefully acknowledge the hard work of Amy Hilley, Anthony Catalanotti, Sharon Marazzo, Machel Hunt, Nora Douglas, Kailip Boonrai, Anthony Surace, and Dr. Kristi Gamarel. We also thank the participants who gave their time and energy to SPARK.


This study was funded by the National Institute of Alcohol Abuse and Alcoholism (R01AA022067).

Compliance with Ethical Standards

Conflict of interest

Sarit Golub received study drug for use in this research from Gilead Sciences. Rachel Fikslin declares she has no conflict of interest. Matthew Goldberg declares he has no conflict of interest. Stephanie Peña declares she has no conflict of interest. Asa Radix declares he has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2016. HIV Surveill Rep. 2017;28:1–125.Google Scholar
  2. 2.
    US Food and Drug Administration. Truvada for PrEP fact sheet: ensuring safe and proper use. 2014;1–2.Google Scholar
  3. 3.
    Smith DK, Van Handel M, Wolitski RJ, Stryker JE, Hall HI, Prejean J, et al. Vital signs: estimated percentages and numbers of adults with indications for preexposure prophylaxis to prevent HIV acquisition—United States, 2015. MMWR Morb Mortal Wkly Rep. 2015;64(46):1291–5.CrossRefGoogle Scholar
  4. 4.
    Parsons JT, Rendina HJ, Lassiter JM, Whitfield TH, Starks TJ, Grov C. Uptake of HIV pre-exposure prophylaxis (PrEP) in a national cohort of gay and bisexual men in the United States. JAIDS J Acquir Immune Defic Syndr. 2017;74(3):285–92.CrossRefGoogle Scholar
  5. 5.
    Hood JE, Buskin SE, Dombrowski JC, Kern DA, Barash EA, Katzi DA, et al. Dramatic increase in preexposure prophylaxis use among MSM in Washington state. Aids. 2016;30(3):515–9.Google Scholar
  6. 6.
    Holloway IW, Dougherty R, Gildner J, Beougher SC, Pulsipher C, Montoya JA, et al. Brief report: PrEP uptake, adherence, and discontinuation among California YMSM using geosocial networking applications. J Acquir Immune Defic Syndr. 2017;74(1):15–20.CrossRefGoogle Scholar
  7. 7.
    Highleyman L. PrEP use is rising fast in US, but large racial disparities remain. Accessed 7 Apr 2017.
  8. 8.
    Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson D, Mayer KH. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care. 2017;29(11):1351–8.CrossRefGoogle Scholar
  9. 9.
    Pingel ES, Rolle C-P, Kelley C, Rosenberg E, Stephenson R, Sullivan P, et al. O02.4 It’s just not for me: exploring low prep uptake among young black men who have sex with men in the Southern United States. Sex Trans Infect. 2017;93(Suppl 2):A4.Google Scholar
  10. 10.
    Hojilla JC, Vlahov D, Crouch P-C, Dawson-Rose C, Freeborn K, Carrico A. HIV pre-exposure prophylaxis (PrEP) uptake and retention among men who have sex with men in a community-based sexual health clinic. AIDS Behav. 2017. Scholar
  11. 11.
    Saunders JB, Aasland OG, Babor TF, De la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804.CrossRefGoogle Scholar
  12. 12.
    Golub SA, Gamarel KE. Psychometric evaluation of the Condom Barriers and Motivations Scale (CBMS). J Behav Med. 2017;40(3):494–505.CrossRefGoogle Scholar
  13. 13.
    Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Pat Care STDS. 2013;27(4):248–54.CrossRefGoogle Scholar
  14. 14.
    Champion VL. Instrument development for health belief model constructs. Adv Nurs Sci. 1984;6:73–85.CrossRefGoogle Scholar
  15. 15.
    Starks TJ, Rendina HJ, Breslow AS, Parsons JT, Golub SA. The psychological cost of anticipating HIV stigma for HIV-negative gay and bisexual men. AIDS Behav. 2013;17(8):2732–41.CrossRefGoogle Scholar
  16. 16.
    Reyna VF. A theory of medical decision making and health: fuzzy trace theory. Med Decis Making. 2008;28(6):850–65.CrossRefGoogle Scholar
  17. 17.
    Horne R, Faasse K, Cooper V, Diefenbach MA, Leventhal H, Leventhal E, et al. The perceived sensitivity to medicines (PSM) scale: an evaluation of validity and reliability. Br J Health Psychol. 2013;18(1):18–30.CrossRefGoogle Scholar
  18. 18.
    Johnson MO, Neilands TB, Dilworth SE, Morin SF, Remien RH, Chesney MA. The role of self-efficacy in HIV treatment adherence: validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). J Behav Med. 2007;30(5):359–70.CrossRefGoogle Scholar
  19. 19.
    Tabachnick BG, Fidell LS. Using multivariate statistics. Boston: Allyn & Bacon/Pearson Education; 2007.Google Scholar
  20. 20.
    Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: Guilford Publications; 2017.Google Scholar
  21. 21.
    Sevelius JM, Keatley J, Calma N, Arnold E. ‘I am not a man’: trans-specific barriers and facilitators to PrEP acceptability among transgender women. Glob Public Health. 2016;11(7–8):1060–75.CrossRefGoogle Scholar
  22. 22.
    Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2015. HIV Surveillance Report. 2016;27:1–114.Google Scholar
  23. 23.
    Sen S, Nguyen HD, Kim SY, Aguilar J. HIV knowledge, risk behavior, stigma, and their impact on HIV testing among Asian American and Pacific Islanders: a review of literature. Soc Work Public Health. 2017;32(1):11–29.CrossRefGoogle Scholar
  24. 24.
    The Lancet HIV. U = U taking off in 2017. Lancet HIV. 2017;4(11):e475.CrossRefGoogle Scholar
  25. 25.
    Golub SA, Gamarel KE. The impact of anticipated HIV stigma on delays in HIV testing behaviors: findings from a community-based sample of men who have sex with men and transgender women in New York City. AIDS Pat Care STDs. 2013;27(11):621–7.CrossRefGoogle Scholar
  26. 26.
    Earnshaw VA, Smith LR, Chaudoir SR, Lee I-C, Copenhaver MM. Stereotypes about people living with HIV: implications for perceptions of HIV risk and testing frequency among at-risk populations. AIDS Educ Prev. 2012;24(6):574–81.CrossRefGoogle Scholar
  27. 27.
    Young SD, Nussbaum AD, Monin B. Potential moral stigma and reactions to sexually transmitted diseases: evidence for a disjunction fallacy. Pers Soc Psychol Bull. 2007;33(6):789–99.CrossRefGoogle Scholar
  28. 28.
    Bandura A. Social cognitive theory: an agentic perspective. Annu Rev Psychol. 2001;52(1):1–26.CrossRefGoogle Scholar
  29. 29.
    Fisher WA, Fisher JD, Harman J. The information–motivation–behavioral skills model: a general social psychological approach to understanding and promoting health behavior. Soc Psychol Found Health Illn. 2003;1:82–106.CrossRefGoogle Scholar
  30. 30.
    Faasse K, Grey A, Horne R, Petrie KJ. High perceived sensitivity to medicines is associated with higher medical care utilisation, increased symptom reporting and greater information-seeking about medication. Pharmacoepidemiol Drug Saf. 2015;24(6):592–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyHunter College of the City University of New YorkNew YorkUSA
  2. 2.Basic and Applied Social Psychology (BASP) PhD Program, Department of PsychologyGraduate Center of the City University of New YorkNew YorkUSA
  3. 3.Callen-Lorde Community Health CenterNew YorkUSA

Personalised recommendations