Date of Award

Fall 10-26-2018

Degree Type


Degree Name

Doctor of Nursing Science (DNS)



Committee Chair

Richard Sowell, PhD, RN

First Committee Member

Barbara Blake, PhD, RN

Second Committee Member

Gloria Taylor, PhD, RN

Third Committee Member

Evelina Sterling, PhD, MPH


In 2012, the first pharmacological HIV preventative agent, pre-exposure prophylaxis (PrEP) was approved in the U.S. for individuals at high-risk of contracting HIV. Men who have sex with men (MSM) are at increased HIV risk, due to their engagement in anal intercourse (AI), which is the most common mode of HIV transmission and the riskiest type of sex. Although evidence indicates that most PrEP paients are MSM, a paucity of evidence exists on MSM’s PrEP initation decision-making process. The purpose of this study was to explore how HIV-negative MSM engaging in protected or unprotected AI decide to initiate PrEP based on the evaluation and perceptions pertaining to their: (a) PrEP knowledge and HIV risk(s)/concern(s); (b) personal and social motivations to initiate PrEP; and (c) behavioral skills and abilities to adhere to PrEP. Guided by the Information-Motivation Behavioral (IMB) skills model, a six-item questionnaire was constructed and used to conduct one-on-one semi-structured interviews. Fourteen MSM (71% African-American) living in the Southern U.S. consented to an interview between March and August of 2018. Several themes emerged from the inductive content analysis, and these themes were categorized into five broader concepts: (1) acknowledged HIV-risks, (2) HIV concerns, (3) PrEP understanding, (4) PrEP accessibility, and (5) PrEP consideration. On further analysis, the data revealed the PrEP Initiation Decision-making (PID) model, a conceptualization of this sample’s non-linear thoughtful process of weighing and evaluating their perceptions and attitudes surrounding these five factors in deriving at their decision to initiate PrEP. The findings give insight into the PrEP initiation decision-making process of an HIV-vulnerable population. Knowledge of patients’ rationale and decision-making process for initiating PrEP allows nursing professionals to provide in-depth PrEP patient education, ensuring that patients receive accurate and complete PrEP information including the (1) relationship between adherence and efficacy; (2) utilization of traditional risk-reduction behaviors in conjunction with PrEP; and (3) the availability of financial assistance programs. This study’s evidence is foundational, establishing a knowledge base for PrEP initiation inquiries in the MSM and other PrEP patient populations in the U.S.