Abstract: Explaining the Intention to Use HIV Pre-Exposure Prophylaxis Among HIV-Negative Men Who Have Sex with Men in Switzerland: Testing an Extended Explanatory Model Drawing on the Unified Theory of Acceptance and Use of Technology (UTAUT) (Society for Social Work and Research 21st Annual Conference - Ensure Healthy Development for all Youth)

Schedule:

Friday, January 13, 2017

Bissonet (New Orleans Marriott)

* noted as presenting author

Daniel Gredig, PhD, Professor for Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland

Sibylle Nideröst, PhD, Professor for Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland

Benedikt Hassler, MA, Research fellow, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland

Franziska Uggowitzer, MSc, Research fellow, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland

Patrick Weber, BA, Research Assistant, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland

Background and Purpose

Men who have sex with men (MSM) continue to be disproportionally affected by HIV/AIDS. In Switzerland, almost half of the HIV infections yearly diagnosed are in MSM. Although HIV pre-exposure prophylaxis (PrEP) has not been approved in Switzerland, there is a discussion about its potential and adequacy as an additional prevention option especially for MSM. In the USA, PrEP was approved in 2012. However, there is evidence that MSM are not keen to use it. Against this background, it is important to learn more about factors influencing the acceptability of PrEP. The aim of this study was to explain the intention to use PrEP among MSM living in Switzerland by developing and testing a model based on the Unified Theory of Acceptance and Use of Technology (UTAUT). The UTAUT includes performance expectancy, effort expectancy, social influence, and age as predictors of the intention to use. The extended model additionally considered further PrEP related aspects (concerns about PrEP, PrEP-related stigma), HIV-protection related aspects (attitudes towards condoms, experiences in condom use, sexual risk behavior, sexually transmitted infections) and resources (age, education, somatic culture, income).

Methods

The study design was cross-sectional. During an eight-month period, we collected data using a self-administered standardized questionnaire, either online or paper-and-pencil. We gathered a convenience sample of 556 MSM. Participants were addressed by flyers, advertisements in gay magazines, social media, specific dating web pages, and gay health clinics. We analyzed the data by descriptive and bivariate statistics. The model was tested by means of structural equation modelling using the generalized least square estimates method.

Results

The mean age of the respondents was 41 years (SD=11.9). Almost half (44%) of the participants held a university degree. The median annual income was between CHF 91'001 and CHF 104'000. About 84% have had sex with a casual partner during the past 6 month. Fifty-three percent have always used a condom when having sex with these casual partners.

The intention to use PrEP was moderate (M=3.7, SD=2.1). Analysis showed that the intention was predicted by performance expectancy (β=0.24, p<.000), effort expectancy (β=–0.18, p<.000), social influence (β=0.30, p<.000), concerns (β=–0.19, p<.000), as well as attitudes towards condoms (β=-0.08, p<.018), negative experiences in condom use (β=0.08, p<.030), and age (β=–0.08 p<.015). The PrEP-related predictors proved to be determined by HIV-protection related aspects (sexual risk behavior, attitudes towards condoms, negative experiences in condom use, STI diagnosis, PrEP-related stigma), age, income, and education. Somatic culture determined the expected effort, negative experiences in condom use, and PrEP-related stigma. (CMIN/df=1.03; AGFI=0.968; SRMR=0.0269; adj.R²=0.51).

Conclusion

The model proved to have a good fit and strong explanatory power. In detail, the findings suggest that the intention to use PrEP is not only determined by anticipations related to PrEP (as expected performance, efforts or concerns) and social influence. It also seems to be determined by HIV-protection related attitudesand behavioral patterns drawing from biographical experiences and therefore, in place before PrEP came into the participants’ view. Further – mediated – predictors are personal, cultural and economic resources.

195P Explaining the Intention to Use HIV Pre-Exposure Prophylaxis Among HIV-Negative Men Who Have Sex with Men in Switzerland: Testing an Extended Explanatory Model Drawing on the Unified Theory of Acceptance and Use of Technology (UTAUT)