Abstract
Introduction: Pre-Exposure Prophylaxis (PrEP) is medication used to prevent the spread of human immunodeficiency virus (HIV). Populations with increased need of HIV prevention (e.g., men who have sex with men [MSM]) are eligible for PrEP for free in the UK. However, HIV surveillance reports indicate stagnated uptake of the drug, alongside increasing rates of HIV acquisition. As such, psychosocial research is needed to explore social barriers to PrEP uptake. This study aimed to explore the role of identity resilience (i.e., ability to maintain a positive and stable sense of self) as a predictor for PrEP usage. It was hypothesised that PrEP self-efficacy (i.e., belief in one’s ability to take PrEP) would be positively predicted by PrEP Acceptability. It was also hypothesized that identity worth and identity continuity (components of identity resilience) would be associated with PrEP acceptability and PrEP self-efficacy. These would be mediated by mistrust in science, PrEP stigma, and perceived risk of HIV.
Methods: 500 MSM, who were assigned male at birth, aged 18 or above, and HIV negative, participated in an online cross-sectional, psychometric study between June and September in 2023. Participants had to be based in the UK but could either be PrEP or non-PrEP users. Structural equation modelling (SEM) was used to explore a model of best fit to test the hypotheses.
Results: Participants were aged 18-73 (M = 35.61, SD = 9.95), mostly white (91.2%), educated to an undergraduate level or above (70.9%) and non-PrEP users (58.2%). Model Fit was satisfactory: χ² = 4.51, df = 3, p = 0.209, CFI = 0.997, TLI = 0.972, RMSEA = 0.032, SRMR = 0.011. Identity worth was positively associated with PrEP self-efficacy. Identity worth was indirectly associated with PrEP acceptability and PrEP self-efficacy. The positive association of identity worth and PrEP acceptability is mediated through lower mistrust of science and lower PrEP stigma but not perceived risk of HIV.
Conclusions: Results indicate that the decision to take PrEP is associated with the constructs of identity worth (i.e., self-esteem, self-efficacy, and distinctiveness) rather than risk-based appraisals alone. That is, the reasons for accessing and utilising PrEP may no longer be motivated by an inherent perceived risk of HIV acquisition. When trying to increase PrEP uptake, addressing specific parts of identity resilience may be beneficial. For example, therapeutic interventions (e.g., counselling) could include interventions to improve positive sexual identities and self-esteem.
Methods: 500 MSM, who were assigned male at birth, aged 18 or above, and HIV negative, participated in an online cross-sectional, psychometric study between June and September in 2023. Participants had to be based in the UK but could either be PrEP or non-PrEP users. Structural equation modelling (SEM) was used to explore a model of best fit to test the hypotheses.
Results: Participants were aged 18-73 (M = 35.61, SD = 9.95), mostly white (91.2%), educated to an undergraduate level or above (70.9%) and non-PrEP users (58.2%). Model Fit was satisfactory: χ² = 4.51, df = 3, p = 0.209, CFI = 0.997, TLI = 0.972, RMSEA = 0.032, SRMR = 0.011. Identity worth was positively associated with PrEP self-efficacy. Identity worth was indirectly associated with PrEP acceptability and PrEP self-efficacy. The positive association of identity worth and PrEP acceptability is mediated through lower mistrust of science and lower PrEP stigma but not perceived risk of HIV.
Conclusions: Results indicate that the decision to take PrEP is associated with the constructs of identity worth (i.e., self-esteem, self-efficacy, and distinctiveness) rather than risk-based appraisals alone. That is, the reasons for accessing and utilising PrEP may no longer be motivated by an inherent perceived risk of HIV acquisition. When trying to increase PrEP uptake, addressing specific parts of identity resilience may be beneficial. For example, therapeutic interventions (e.g., counselling) could include interventions to improve positive sexual identities and self-esteem.
Original language | English |
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Journal | Hiv medicine |
Publication status | Accepted/In press - 25 Jan 2025 |