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Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> is an efficacious <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> prevention strategy recommended for use with condoms but still protective in their absence. Concern about the impact of Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> on condom use and other risk behaviour is, nonetheless, among the barriers to prescription commonly reported. To understand the implications of this concern for Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> access, we examined how medical students\u2019 willingness to prescribe Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> varied by patients\u2019 condom use and partnering practices. We also assessed the perceived acceptability of various reasons for condom discontinuation with Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An online survey was distributed to 854 medical students in the Northeastern <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content> in 2015. Participants (n\u00a0=\u00a0111) were surveyed about their willingness to prescribe Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> for each of six male patients who systematically differed in their reported condom use (sustained use, sustained nonuse, or discontinuation with Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content>) and partnering practices (single male partner with untreated <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> or multiple male partners of unknown <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> status). Participants also reported perceived acceptability of four reasons for condom discontinuation: pleasure, sexual functioning, intimacy, and conception.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Willingness to prescribe Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> was inconsistent with patient risk: When the patient used condoms and planned to sustain condom use, most participants were willing to prescribe Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> \u2013 93% if the patient had a single partner and 86% if the patient had multiple partners. Fewer were willing to prescribe if the patient did not use condoms and planned to sustain nonuse (53% and 45%, respectively) or used condoms but planned to discontinue use (27% and 28%). Significantly fewer participants were willing to prescribe for a patient with multiple partners versus a single partner when the patient reported sustained condom use or sustained condom nonuse. The number of participants who were willing to prescribe was similarly low for a patient with multiple partners versus a single partner when the patient reported that he planned to discontinue condom use. More participants accepted a patient discontinuing condoms for conception (69%) than for intimacy (23%), pleasure (14%), or sexual functioning (13%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Medical students\u2019 clinical judgments were misaligned with patient risk and suggest misconceptions or personal values may undermine provision of optimal <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> prevention services.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25147","type":"journal-article","created":{"date-parts":[[2018,6,25]],"date-time":"2018-06-25T15:34:31Z","timestamp":1529940871000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Prevention paradox: Medical students are less inclined to prescribe HIV pre\u2010exposure prophylaxis for patients in highest need"],"prefix":"10.1002","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2640-0208","authenticated-orcid":false,"given":"Sarah K","family":"Calabrese","sequence":"first","affiliation":[{"name":"Department of Psychology George Washington University Washington DC USA"},{"name":"Social and Behavioral Sciences Department Yale School of Public Health Yale University New Haven CT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie A","family":"Earnshaw","sequence":"additional","affiliation":[{"name":"Department of Human Development and Family Studies University of Delaware Newark DE USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen","family":"Underhill","sequence":"additional","affiliation":[{"name":"Columbia Law School Columbia University New York NY USA"},{"name":"Heilbrunn Department of Population &amp; Family Health Mailman School of Public Health Columbia University New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas S","family":"Krakower","sequence":"additional","affiliation":[{"name":"The Fenway Institute Fenway Health Boston MA USA"},{"name":"Beth Israel Deaconess Medical Center Harvard Medical School Harvard University Boston MA USA"},{"name":"Department of Population Medicine Harvard Medical School Harvard University Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manya","family":"Magnus","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics Milken Institute School of Public Health George Washington University Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan B","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Health Promotion and Behavior College of Public Health University of Georgia Athens GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7460-733X","authenticated-orcid":false,"given":"Kenneth H","family":"Mayer","sequence":"additional","affiliation":[{"name":"The Fenway Institute Fenway Health Boston MA USA"},{"name":"Beth Israel Deaconess Medical Center Harvard Medical School Harvard University Boston MA USA"},{"name":"Department of Global Health and Population Harvard TH Chan School of Public Health Harvard University Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph R","family":"Betancourt","sequence":"additional","affiliation":[{"name":"Disparities Solutions Center Massachusetts General Hospital Harvard Medical School Harvard University Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trace S","family":"Kershaw","sequence":"additional","affiliation":[{"name":"Social and Behavioral Sciences Department Yale School of Public Health Yale University New Haven CT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John F","family":"Dovidio","sequence":"additional","affiliation":[{"name":"Social and Behavioral Sciences Department Yale School of Public Health Yale University New Haven CT USA"},{"name":"Department of Psychology Yale University New Haven CT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,6,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001145"},{"key":"e_1_2_9_3_1","unstructured":"US Public Health Service.Preexposure prophylaxis for the prevention of HIV infection in the United States \u2013 2017 update: a clinical practice guideline.2018. 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