Relationship dynamics and pre-exposure prophylaxis (PrEP) adherence self-efficacy among men who have sex with men (MSM) in romantic relationships

Background: Evidence suggests that optimal health behaviors among couples arise out of relationship quality and goal congruence, which is the extent to which partners’ goals are aligned. The purpose of the study was to examine: (1) the sexual health goals of HIV-negative MSM who initiated PrEP; and (2) whether perceptions of relationship quality and sexual health goal congruence with their partner predicted PrEP adherence self-efficacy.

Methods: As part of an ongoing PrEP demonstration-implementation project, analyses were conducted among a subsample of HIV-negative MSM in romantic relationships who completed baseline and 3-month follow up assessments (N = 60). Participants mean age was 33.3; 46.6% were racial/ethnic minority; 30.9% earned less than a Bachelor’s degree; 58.8% had an open sexual agreement; and 47.1% had an HIV-positive partner. Sexual health goals were qualitatively coded and thematically analyzed. Regression models examined associations between goal congruence and relationship quality at baseline on PrEP adherence self-efficacy at follow-up, adjusting for age, education, partner HIV-status, and substance use.

Results: Men in serodiscordant relationships’ top sexual health goals were to protect themselves from HIV and enhance sexual satisfaction with their partner; whereas men in relationships with HIV-negative partners’ sexual health goals were to protect themselves and their partners from HIV and have responsible sex. Greater relationship quality was associated with higher PrEP adherence self-efficacy (β=0.34, p<0.05).

Conclusions: Findings suggest that relationship dynamics may influence PrEP use and adherence. Examining relationship dynamics, including couples’ health goals and partner support for PrEP use represents an important area for future research.