Loss-Framed Messages to Reduce Sexual Risk Compensation associated with Pre-Exposure Prophylaxis

Date of Award

August 2020

Degree Type


Degree Name

Doctor of Philosophy (PhD)




Peter A. Vanable

Subject Categories

Social and Behavioral Sciences


Pre-exposure prophylaxis (PrEP) is a highly efficacious biomedical approach to HIV prevention in which HIV-negative individuals take daily antiretroviral medication to reduce the likelihood of seroconversion. However, the potential for decreased condom use with PrEP (i.e., sexual risk compensation) may limit the effectiveness of PrEP in clinical practice and contribute to rising national sexually transmitted infection (STI) rates. Thus, interventions to reduce sexual risk compensation are needed if PrEP is to improve sexual health outcomes. This study is a pilot feasibility and acceptability trial of an adapted loss-framed message intervention to reduce sexual risk compensation associated with PrEP. In the formative research phase, two focus groups with PrEP users (N = 7) were conducted to elicit opinions of conjoined behavioral and biomedical HIV prevention strategies, obtain feedback on the provisional loss-framed intervention messages, and assess barriers to study participation. In the pilot trial, the adapted loss-framed message intervention was compared to a gain-framed message intervention and enhanced skills (control) condition in a sample of PrEP users (N = 29) using a three group between subjects repeated measures design. Both the loss- and gain-framed message interventions were feasible to administer and acceptable to study participants. However, contrary to study hypotheses, it was the gain-framed, as opposed to loss-framed, message intervention that increased condom use motivation immediately post-intervention. Neither the gain- or loss-framed message intervention resulted in greater perceived risk of condomless sex with PrEP or decreased sexual risk compensation intentions, assessed immediately post-intervention, or more frequent condom use assessed three-months later. Further refinement and testing in a fully powered randomized controlled trial are needed before a definitive recommendation on the efficacy of the gain-framed message intervention can be made based on this work.


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