PrEP acceptability and self-efficacy in men who have sex with men: the roles of identity, trust and knowledge

This study investigates psychosocial and structural predictors of pre-exposure prophylaxis (PrEP) acceptability and self-efficacy, addressing the need for targeted interventions to improve PrEP uptake in the United Kingdom (UK). A cross-sectional, online survey was conducted among UK-based men who have sex with men not currently using PrEP (N = 246). Participants completed validated measures assessing identity resilience, LGBTQ+ connectedness, outness, medical mistrust, perceptions of the NHS, and HIV knowledge. Structural equation modelling (SEM) was used to examine the relationships between these psychosocial factors and PrEP acceptability and self-efficacy, while controlling for age, previous sexually transmitted infection diagnosis, and condomless sex. The SEM demonstrated excellent model fit. PrEP acceptability was positively associated with LGBTQ+ connectedness and negatively associated with medical mistrust. Conversely, PrEP self-efficacy was positively associated with identity resilience, outness, NHS perceptions, and HIV knowledge. Findings show that the predictors of PrEP acceptability and self-efficacy are different, which should help inform interventions for promoting PrEP use. Enhancing LGBTQ+ connectedness and reducing medical mistrust may increase PrEP acceptability, while fostering identity resilience, outness, and positive perceptions of the NHS could strengthen PrEP self-efficacy. This study identifies distinct yet complementary predictors of PrEP acceptability and self-efficacy, emphasising the necessity for tailored interventions.