Diagnosing PrEP Communication Self-Efficacy in a Community-Based Peer Leader Intervention for Black Sexual Minority Men

Abstract

HIV prevention interventions that leverage endogenous peer leaders to communicate about Pre-Exposure Prophylaxis (PrEP) and other HIV prevention tools in their social networks offer a way to reach greater portions of communities most impacted by HIV like Black/African American gay, bisexual, same gender-loving, and other sexual minority men (BSMM). However, the success of these interventions hinge on the communication self-efficacy of its peer leaders. In this exploratory study, we present a multi-theoretical framework that situates the PrEP communication self-efficacy (PCSE) of a cohort of young BSMM peer leaders (n = 303) in the context of personal, behavioral, social, and structural factors. Using censored regression models, our analysis shows that PCSE is influenced by evaluations of PrEP itself (its relative advantage, complexity, and compatibility), network embeddedness (degree centrality) among other BSMM, social media network exposure to HIV information, and medical mistrust. We conclude with a discussion of the practical implications of our findings for intervention design and implementation.

Keywords: Black/African american; Communication self-efficacy; HIV prevention; Peer leaders; Pre-exposure prophylaxis; Sexual minority men; Social network interventions.

Fig. 1

A multi-theoretical conceptual model of PrEP communication self-efficacy among young Black sexual minority men, including constructs associated with (clockwise from top left to bottom left): (A) Self-Efficacy Theory, (B) Diffusion of Innovations, (C) Social Network Theory, and (D) Social Determinants of Health