Correlates of confidence to utilize non-occupational Post-Exposure Prophylaxis (PEP) if needed among sexual minority men in relationships

Background: Non-occupational post-exposure prophylaxis (PEP) is an underutilized biomedical prevention strategy and may be beneficial for sexual minority men (SMM) who are in relationships and not currently taking pre-exposure prophylaxis (PrEP). The goal of this study was to examine relationship characteristics as well as behavioral and structural correlates of confidence to utilize PEP if needed. Methods: A sample of 5,370 partnered SMM not taking PrEP completed an online survey. Bivariate comparisons evaluated differences in confidence to utilize PEP. An ordinal regression determined whether the association between relationship quality and confidence to utilize PEP was moderated by sexual agreements. Results: Fifty-seven percent of the sample endorsed feeling highly confident they would utilize PEP if needed. Relationship quality had a significant and positive relationship with confidence to utilize PEP among SMM in relationships with non-monogamous agreements (OR = 1.01; p < .001), but not among those with monogamous agreements (OR = 0.99; p = .462). At high levels of relationship quality, SMM in relationships with non-monogamous agreements were significantly more confident in their ability to utilize PEP if needed (OR = 1.27; p = .005), but not at low levels of relationship quality (OR = 0.89; p = .185). Feeling confident in accessing and affording PEP was associated with confidence in utilizing PEP over and above HIV testing frequency and previously taking PrEP. Conclusions: HIV prevention services for partnered SMM, like couples HIV testing and counseling or PrEP navigation, should stress PEP as an alternative option during a potential exposure event.