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Willingness to Prescribe PrEP to Bisexual Men Depends on Genders of Their Past Partners: A Study of Medical Students in the USA

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Abstract

Bisexual men are at increased risk for HIV compared to heterosexual men but unlikely to use pre-exposure prophylaxis (PrEP). Given that biases may influence whether bisexual men are prescribed PrEP, we examined whether medical students’ decision-making was influenced by the genders of a bisexual male patient’s partners. Medical students (N = 718) were randomized to one of nine conditions where they answered questions about a bisexual male patient after reviewing his electronic medical record. We manipulated the gender of his current partner (none, male, female) and the genders of his past partners (male, female, both). Current partners were described as living with HIV and not yet virally suppressed, past partners were described as being of unknown HIV-status, and condom use was described as intermittent with all partners. When the patient was not in a current relationship, perceived HIV risk and likelihood of prescribing PrEP were lowest if he only had female partners in the past. When he was in a current relationship, perceived HIV risk and likelihood of prescribing PrEP did not differ based on current or past partners’ genders. In addition, identification as a PrEP candidate, perceived likelihood of adherence, and perceived likelihood of engaging in condomless sex if prescribed were lower when the patient was not in a current relationship. Medical students appropriately prioritized the status of the partner living with HIV, but their decision-making was influenced by past partner genders when the patient was not in a current relationship. Medical students may require additional education to ensure they understand PrEP eligibility criteria and make decisions based on patients’ individual presentations.

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Data are available from the lead author upon request.

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Syntax for statistical analyses are available from the lead author upon request.

Notes

  1. We re-ran our analyses including PrEP knowledge as a covariate and the pattern of significant findings remained the same.

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Funding

This project was supported by a grant from Gilead Sciences under award number [IN-US-412-9042]. The funder had no input on study design, implementation, data analysis, interpretation of results, drafting of the report, or the decision of where to submit the report for publication. Brian Feinstein’s time was supported by a grant from the National Institute on Drug Abuse [K08DA045575]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

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Correspondence to Brian A. Feinstein.

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The authors declare that they have no conflict of interest.

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Informed consent to participate was obtained from all participants.

Research Involving Human Participants and/or Animals

All study procedures were approved by the Institutional Review Board at Rosalind Franklin University of Medicine and Science prior to implementation. The study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Feinstein, B.A., Chang, C.J., Bunting, S.R. et al. Willingness to Prescribe PrEP to Bisexual Men Depends on Genders of Their Past Partners: A Study of Medical Students in the USA. Arch Sex Behav 51, 2535–2547 (2022). https://doi.org/10.1007/s10508-022-02337-0

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  • DOI: https://doi.org/10.1007/s10508-022-02337-0

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