Identifying preferences for receiving HIV prevention services among GBMSMs and for providing HIV prevention services among HCPs who are active-duty service members

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PROJECT SUMMARY The proposed research project addresses an important gap in HIV prevention by applying innovative methods to help bolster uptake of HIV Pre-Exposure Prophylaxis (PrEP), as well as identify ways to improve the delivery of sexual health services among active-duty service members in the US military who are at most risk for HIV acquisition: gay, bisexual, and other men who have sex with men (GBMSM). Annually, the military diagnoses approximately 350 new HIV infections, with 236 new HIV infections occurring in 2020, and another 433 new infections diagnosed between January 1, 2021, through June 30, 2022. HIV PrEP is a highly effective prevention strategy, currently underutilized by active-duty service members. When taken as directed, PrEP is ~99% effective at reducing HIV-seroconversion in at-risk populations, such as GBMSM. Despite authorization to provide PrEP and related care free of cost, PrEP uptake among active-duty service members is low. Prior research has noted psychosocial barriers, such as stigma, may exist from residuals of the ‘Don’t Ask, Don’t Tell’ policy era that emphasized hiding one’s identity as a lesbian, gay, bisexual, or transgender (LGBT) and engagement in same-sex behaviors. Other factors may impede uptake-provision of PrEP, such as one’s comfort level of discussing sex-related topics and identifying whether someone is a candidate for PrEP. Currently, there is limited data describing what factors affect active-duty service members’ demand for PrEP and what factors influence providers’ willingness to prescribe it. The proposed project – from a promising doctoral student with a strong mentorship team – will apply an exploratory sequential mixed-method preference-based study to identify how best to bolster the uptake-delivery of sexual health and HIV prevention, including PrEP, among GBMSM and healthcare providers (HCP) who are active-duty service members in the US military. The integrated behavioral model (IBM) will guide the study to accomplish the proposed Specific Aims: (1) Qualitatively explore preferences for receiving sexual health services, including PrEP, among active-duty GBMSM and explore preferences for receiving sexual health services, including PrEP, among active-duty HCP service members. (2) Quantitatively identify, describe, and compare HIV/STI prevention program preferences among active-duty GBMSM and active-duty HCPs using Choice-Based Conjoint and MaxDiff preference-based methods. Findings from this timely, innovative project will identify ways to tailor sexual health services to the individual’s risk profile, merge overlapping concepts from the patient and provider perspective, facilitate more patient-centered provision of sexual health services, and optimize PrEP uptake among GBMSM service members, and PrEP provision among HCPs in the military.