Experiences of HIV postexposure prophylaxis (PEP) among highly exposed men who have sex with men (MSM)

Abstract

Twenty-three patients were eligible for the qualitative study. Thirteen interviews were carried out. All patients were 20-60-year-old MSM. The median time between PEP and HIV diagnosis was 3.3 years (interquartile range (IQR)=0.9-4.9). Many participants reported negative PEP experiences: awkward access to the PEP clinic, uneasiness and shame in the hospital setting, unpleasant interaction and moral disapprobation from the medical staff, treatment intolerance and prevention messages that were 'inconsistent with real life' CONCLUSION: Our data highlight PEP management failures among its target population that may have compromised any subsequent attempts to seek out PEP. Practitioners should be more aware of MSM sexual contexts and practices. PEP consultations should provide the opportunity to discuss prevention strategies with highly exposed HIV-negative subjects, which may include pre-exposure prophylaxis.

PrEP (HIV pre-exposure prophylaxis) and its possibilities for clinical practice

“…(Cooper) Insofar as the ability to demonstrate a nuanced, open and non-judgmental understanding of the sexual lives of patients is an important factor in HIV healthcare (cf. Palich et al, 2017), there is something of a resonance here with what Maria Puig de la Bellacasa (2017:4) has argued for as 'a politics of care' that, as she puts it, 'engages much more than a moral stance; it involves affective, ethical, and hands-on agencies of practical and material consequence'. Nevertheless, given our interviewees were at the front line of approaching health as a static condition, presumed to be preserved against a pathological viral or bacterial agent (Canguilhem, 1989) or, indeed, a potentially destructive 'chemsex' drug (McCall et al, 2015), much of what we have included here suggests that PrEP not only warrants a reconfiguring of the prevailing conceptions of risk but, more particularly, how it aligns with what can be made possible for the cultures it is intended to serve.…”

Highlights from this issue

“…Other research topics this month include dual syphilis and HIV screening and diagnostics,7 8 HIV post-exposure prophylaxis for MSM,9 and concordance between partners for Trichomonas vaginalis 10. We also have some thought provoking reflections for our clinical readers about anal cancer in women,11 a challenging perspective on medical communication from a linguist12 and of course our much loved Clinical Round-Up 13…”

Drug users’ perceptions, demands, and suggestions for non-occupational post-exposure prophylaxis (nPEP) services in China: a qualitative study

“…Some participants claimed that they were not likely to accept nPEP if adverse drug reactions were intolerable. In previous studies, adverse effects were always one of the important barriers of nPEP implement [27][28][29][30]. But in general, the side effects of ARV medication for most subjects within a short period were relatively moderate, mainly including headache and gastrointestinal symptoms.…”

“…HIV and AIDS-related stigma and discrimination were still common in healthcare settings [37][38][39]. A qualitative study in France reported that physicians' aggressive words in face-to-face interactions could bring up negative personal experiences for subjects with ongoing follow-up for HIV infection and PEP history [30].…”