Pre-exposure prophylaxis (PrEP) reduces sexual risk for HIV transmission by 99% when used appropriately, but remains underutilized among gay, bisexual, and other men who have sex with men (MSM). In this mixed-method study, we describe reasons for PrEP refusal associated with low self-perceived need for PrEP among MSM who recently declined daily oral PrEP when offered by a provider. Data are from a quantitative behavioral survey of MSM (N = 93) living in Atlanta, Chicago, and Raleigh-Durham, who also either responded to an in-depth interview (n = 51) or participated in one of 12 focus groups (n = 42). Themes of low self-perceived need for PrEP were: low self-perceived risk for HIV acquisition (33% of respondents); confidence in remaining HIV-negative (35%); using condoms (81%); limiting number of partners and choosing partners carefully (48%); asking partners about their HIV status before having sex (45%); engaging in safer sexual positions or oral sex (28%); being in a monogamous relationship or exclusivity with one partner (26%); and regular HIV testing (18%). Low self-perceived risk for HIV acquisition and high confidence in other prevention strategies were important factors related to low self-perceived need in MSM refusing daily oral PrEP when offered. Providers should continue to discuss the benefits of PrEP as a safe and highly effective option for HIV prevention.

如果使用得当，暴露前预防 (PrEP) 可将 HIV 传播的性风险降低 99%，但在同性恋、双性恋和其他男男性行为者 (MSM) 中仍未得到充分利用。在这项混合方法研究中，我们描述了 MSM 拒绝 PrEP 的原因，这些原因与 MSM 自我感知的 PrEP 需求较低有关，他们最近拒绝了提供者提供的每日口服 PrEP。数据来自对生活在亚特兰大、芝加哥和罗利-达勒姆的 MSM (N = 93) 进行的定量行为调查，他们也回答了深度访谈 (n = 51) 或参加了 12 个焦点小组之一 (n = 51) = 42）。自我感知的 PrEP 需求低的主题是： 自我感知的 HIV 感染风险低（33% 的受访者）；对保持艾滋病毒阴性的信心（35%）；使用安全套（81%）；限制合作伙伴数量并谨慎选择合作伙伴（48%）；在发生性行为之前询问伴侣的艾滋病毒状况（45%）；采用更安全的性姿势或口交（28%）；与一个伴侣处于一夫一妻制关系或排他性关系（26%）；定期进行艾滋病毒检测（18%）。自我感知的 HIV 感染风险较低以及对其他预防策略的高度信心是 MSM 拒绝每日口服 PrEP 时自我感知需求较低的重要因素。提供者应继续讨论 PrEP 作为安全且高效的艾滋病毒预防选择的好处。