Date of Completion


Embargo Period



Seth C. Kalichman, Diane Quinn, Lisa Eaton

Field of Study

Psychological Sciences


Master of Science

Open Access

Open Access


Black men who have sex with men (BMSM) experience higher HIV incidence rates than any other U.S. population subgroup. The development of a bio-behavioral strategy using anti-retroviral therapy, pre-exposure prophylaxis (PrEP), provides a new alternative for HIV prevention; however, interest and uptake among BMSM remains poor. Gender-based perceptions and roles may be a factor in PrEP interest among BMSM. The present study examined the relationship between avoidance of femininity, heterosexual self-presentation, PrEP stigma and PrEP interest among BMSM. A self-administered questionnaire assessing aspects of traditional masculinity ideology, stigmatized beliefs that PrEP use will out one as gay, and PrEP interest was completed by BMSM attending the 2017 Atlanta Black gay pride festival. Conditional process modeling tested moderated mediation among PrEP stigma, avoidance of femininity, and heterosexual self-presentation. Results partially supported the hypothesized model; the expected direct relationship was observed between avoidance of femininity and interest in PrEP, however, conformity to heterosexual self-presentation produced inconsistent mediation. Further, moderation by PrEP stigma produced contrary findings while controlling for age, openness of sexual orientation, and frequency of previous HIV testing. The present study demonstrates that traditional masculinity ideology and stigmatized beliefs regarding PrEP play a role in PrEP interest among BMSM, and that PrEP may be viewed by some as a means of being “outed” regarding their sexual orientation. Future interventions designed to increase uptake of PrEP in BMSM should be attentive to the role of these contextual psychosocial factors.

Major Advisor

Seth C. Kalichman