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This randomized controlled trial used a mixed-methods approach to examine PrEP acceptance among community-supervised men who use drugs and their female partners. The study evaluated PrEP willingness among participants (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009394) randomized to either PACT (5-session couples\u2019 HIV intervention) or control (1-session HIV counseling). Qualitative interviews with 20 couples (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940) explored PrEP attitudes. The PACT group showed significantly higher intentions to use condoms with PrEP compared to controls (64% vs. 53%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.03). Female partners in the PACT intervention demonstrated stronger PrEP use intentions than females in the control (aOR\u2009=\u20092.85,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.02). Qualitative findings revealed five key factors affecting PrEP acceptance: (1) partner infidelity concerns, (2) substance use and decision-making, (3) HIV acquisition fears, (4) low-risk perception despite objective risk factors, and (5) medical mistrust. Gender influences PrEP acceptance among criminal legal-involved couples. Effective interventions should address gender differences, risk perception disparities, and medical mistrust.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT01690494 registered September 19, 2012.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10461-026-05169-4","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T02:54:10Z","timestamp":1782701650000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cWhy not take that pill?\u201d: A Mixed-Methods Study of Gender, Risk Perception, and PrEP Uptake Among Drug-Involved Heterosexual Couples Under Community Supervision","\"\u00bfPor qu\u00e9 no tomar esa pastilla?\": Un estudio de m\u00e9todos mixtos sobre g\u00e9nero, percepci\u00f3n del riesgo y adopci\u00f3n de la PrEP entre parejas heterosexuales involucradas con drogas bajo supervisi\u00f3n comunitaria"],"prefix":"10.1007","clinical-trial-number":[{"clinical-trial-number":"nct01690494","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3456-2322","authenticated-orcid":false,"given":"Dawn","family":"Goddard-Eckrich","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0418-7602","authenticated-orcid":false,"given":"Srishti Meera","family":"Sardana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0667-9283","authenticated-orcid":false,"given":"Brandy F.","family":"Henry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6612-7035","authenticated-orcid":false,"given":"Dget Lynn","family":"Downey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2715-8310","authenticated-orcid":false,"given":"Louisa","family":"Gilbert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6181-5789","authenticated-orcid":false,"given":"Kristi L.","family":"Stringer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6816-7187","authenticated-orcid":false,"given":"Mingway","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4253-3430","authenticated-orcid":false,"given":"Elwin","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1475-2003","authenticated-orcid":false,"given":"Brittany V.","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie-Ann","family":"Bolden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nell","family":"Mckenna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilal Tinvar","family":"Abbas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7114-7232","authenticated-orcid":false,"given":"Caroline","family":"Prichard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blerta","family":"Baholli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0049-5686","authenticated-orcid":false,"given":"Nabila","family":"El-Bassel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5418-3979","authenticated-orcid":false,"given":"Timothy","family":"Hunt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"5169_CR1","unstructured":"Centers for Disease Control and Prevention. 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