Factors Associated with Pre Exposure Prophylaxis Self-Efficacy Among Men Who Have Sex With Men in the United States

Self-efficacy (SE) is central to sexual health behavior change and may be important for pre-exposure prophylaxis (PrEP) adherence among men who have sex with men (MSM). This study examines factors associated with three PrEP self-efficacy domains: routine adherence (RA), medication management (MM), and overcoming psychosocial challenges (OPC). Three hundred U.S. MSM, who either initiated daily oral PrEP or reported anticipated adherence difficulties, and who all experienced at least one psychosocial syndemic condition, were recruited as part of a randomized controlled trial. Baseline assessments included PrEP SE and psychosocial, structural, and sociodemographic variables. Bayesian variable selection and multiple linear regression identified several predictors. Younger age (RA: b = 0.048, 95% CI [0.025, 0.072]; MM: b = 0.033, 95% CI [0.012, 0.054]; OPC: b = 0.060, 95% CI [0.023, 0.087]) and greater structural barriers (RA: b = − 0.090, 95% CI [-0.151, − 0.029]; MM: b = − 0.192, 95% CI [-0.246, − 0.138]; OPC: b = − 0.145, 95% CI [-0.229, − 0.055]) were associated with decreased SE across all factors ( p < .01). Social anxiety was associated with lower routine adherence SE ( b = − 0.039, 95% CI [-0.063, -0.016], p < .01); lifetime polysubstance use was associated with lower medication management SE ( b = − 0.192, 95% CI [-0.325, -0.058], p < .01); and overseas-born status ( b = − 0.932, 95% CI [-1.759, -0.106], p < .05) and greater sexual compulsivity ( b = − 0.157, 95% CI [-0.269, -0.046], p < .01) were both associated with lower SE in overcoming psychosocial challenges. Findings underscore the need for multilevel, culturally responsive PrEP interventions that promote SE across all three domains.