University of Central Florida STARS Honors Undergraduate Theses UCF Theses and Dissertations 2020 Exploring the Impact of Pre-Exposure Prophylaxis Related to Sexual Behavior in College Men Dalton J. Poe University of Central Florida Part of the Immunoprophylaxis and Therapy Commons, and the Nursing Commons Find similar works at: https://stars.library.ucf.edu/honorstheses University of Central Florida Libraries http://library.ucf.edu This Open Access is brought to you for free and open access by the UCF Theses and Dissertations at STARS. It has been accepted for inclusion in Honors Undergraduate Theses by an authorized administrator of STARS. For more information, please contact [email protected]. Recommended Citation Poe, Dalton J., "Exploring the Impact of Pre-Exposure Prophylaxis Related to Sexual Behavior in College Men" (2020). Honors Undergraduate Theses. 745. https://stars.library.ucf.edu/honorstheses/745 EXPLORING THE IMPACT OF PRE-EXPOSURE PROPHYLAXIS RELATED TO SEXUAL BEHAVIOR IN COLLEGE MEN by DALTON POE A thesis submitted in partial fulfillment of the requirements for the Honors in the Major Program in Nursing in the College of Nursing and in The Burnett Honors College at the University of Central Florida Orlando, Florida Spring Term 2020 Thesis Chair: Dr. Christa Cook ABSTRACT Pre-exposure prophylaxis (PrEP) is an effective tool for preventing human immunodeficiency virus (HIV) acquisition in sexually active at-risk individuals such as men who have sex with men (MSM). The purpose of this study is to examine factors associated with intent to engage in risky sexual behavior among HIV-negative college aged (18-24) MSM who are currently adherent to PrEP or who have expressed interest in the future adoption of PrEP. A multiracial/ethnic sample of 31 men expressing interest in the adoption of PrEP and 6 men currently taking PrEP completed a quantitative survey identifying key themes regarding attitudes towards PrEP and potential behaviors associated with adherence. Themes associated with current adherence to PrEP included protection from HIV infection, the opportunity to engage in sexual activities with a non-condom HIV prevention method, and perceived protection from sexually transmitted infections. Themes associated with potential adoption of PrEP included protection from HIV infection, opportunity to engage in sexual activity with known HIV-positive partners, opportunity to engage in sexual activities with a non-condom HIV prevention method, and perceived protection from sexually transmitted infections. Review found that decreased condom use and increased sexual partners are key themes related to initiation of PrEP, and a decrease in frequency of condom use was indicated among the adherent sample. Other key themes identified include barriers to PrEP implementation and misinformation regarding sexually transmitted infections among the population. i ACKNOWLEDGEMENTS Thank you to my chairperson, Dr. Cook, who welcomed me into the world of research without hesitation and guided me each step of the way. Thank you to Dr. Covelli, who helped me explore my passion and connected me to such an incredible mentor. Thank you to committee member Dr. Loerzel, for providing guidance throughout and always encouraging me to share my endeavor with the world. Thank you also to committee member Dr. Joe, for encouraging me to explore my passions further and allowing me to join her close-knit team. Lastly, thank you to Patrick Healy, nursing mentor and the single most influential person in my decision to pursue research – your support will always inspire me to achieve. ii TABLE OF CONTENTS INTRODUCTION ................................................................................................................................................ 4 Background ....................................................................................................................................................... 4 Prevalence of Risky Sexual Behavior ................................................................................................................ 5 Prevalence of Sexually Transmitted Infections (STIs) ....................................................................................... 6 PrEP for College Aged Young Adults ................................................................................................................. 7 Significance ...................................................................................................................................................... 8 Review of Current Literature. ........................................................................................................................... 8 METHODOLOGY ............................................................................................................................................. 10 Study Design and Instrument .......................................................................................................................... 10 Human Subjects .............................................................................................................................................. 10 Sample and Setting ......................................................................................................................................... 11 Procedures ...................................................................................................................................................... 12 Measurements ................................................................................................................................................. 13 Data Analysis .................................................................................................................................................. 14 RESULTS ........................................................................................................................................................... 14 Demographic Data .......................................................................................................................................... 14 Primary Motivators for Initiating PrEP .......................................................................................................... 15 Sexual Risk Behaviors .................................................................................................................................... 15 Barriers to Implementation ............................................................................................................................. 17 Frequency of Condom Use ............................................................................................................................. 17 DISCUSSION ..................................................................................................................................................... 19 Limitations ...................................................................................................................................................... 22 Recommendations for Education and Practice ............................................................................................... 24 Recommendations for Future Research .......................................................................................................... 25 APPENDIX A: DATA COLLECTION INSTRUMENT ................................................................................... 27 APPENDIX B: DATA COLLECTION INSTRUMENT ................................................................................... 37 APPENDIX C: IRB APPROVAL ...................................................................................................................... 45 APPENDIX D: RECRUITMENT FLYER ......................................................................................................... 47 APPENDIX E: DEMOGRAPHIC TABLE ........................................................................................................ 49 APPENDIX F: MOTIVATORS FOR PrEP USE ............................................................................................... 51 REFERENCES ................................................................................................................................................... 53 iii INTRODUCTION Current evidence supports pre-exposure prophylaxis (PrEP) as an effective means of human immunodeficiency virus (HIV) prevention. Though highly successful at protecting against HIV, the medication does not provide protection against sexually transmitted infections such as syphilis, chlamydia, and gonorrhea. As the use of PrEP continues to rise, so does the concern that drug participation occurs simultaneously with increased sexual risk taking within already at-risk populations such as young adults, men who have sex with men, and those with multiple sexual partners. In 2015 the Centers for Disease Control and Prevention’s Florida State Health Profile reported that over 39,000 people in the United States were diagnosed with HIV (CDC, 2015). Of these, 4,849 diagnoses occurred within the state of Florida alone. This made Florida the 1st among all 50 states in new HIV diagnoses. In the same year, Florida also ranked 6th in primary and secondary syphilis rates (CDC, 2015). Given the state’s high rankings for sexually transmitted diseases, it’s within reason that many Florida persons can be considered at- risk PrEP candidates and are also at a relatively high risk of sexually transmitted