Body/Selves and Beyond: Men’s Narratives of Sexual Behavior on PrEP

Hughes, Shana D.; Sheon, Nicolas; Andrew, Erin; Cohen, Stéphanie; Doblecki-Lewis, Susanne; Liu, Albert Y.

doi:10.1080/01459740.2017.1416608

Cited by 31 publications

(24 citation statements)

References 43 publications

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“…The following account linked the problematising of STIs (and condomless sex) to an ingrained 'pathologisation' of 'sex between men', and a persistent fear of HIV ('the shadow in the corner'). PrEP is positioned here as a way to escape the fear and threat of HIV, as has been observed in other research (Hughes et al 2018, Koester et al 2017). Concerns about STIs or unrestrained sexual behaviour were interpreted as a reactionary, and sex-negative, position on gay men's sexual behaviour:…”

Section: Optimistic/criticalmentioning

confidence: 80%

“…PrEP is positioned here as a way to escape the fear and threat of HIV, as has been observed in other research (Hughes et al . , Koester et al . ).…”

Section: Resultsmentioning

confidence: 99%

“…However, there is growing evidence for the optimistic position that PrEP can engage users in regular sexual health care and significantly reduce the fear of HIV (Hughes et al . , Koester et al . , Lal et al .…”

Section: Discussionmentioning

confidence: 99%

“…It will continue to evolve through its use in practice, particularly as users adjust to and remake what PrEP is (Holt , Hughes et al . , Koester et al . , Newman et al .…”

Section: Discussionmentioning

confidence: 99%

“…Attending to the ways in which users configure and respond to PrEP and its ‘problems’, as others have done, remains critical (Holt , Hughes et al . , Newman et al . ).…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

HIV pre‐exposure prophylaxis and the ‘problems’ of reduced condom use and sexually transmitted infections in Australia: a critical analysis from an evidence‐making intervention perspective

Holt

Newman

Lancaster

et al. 2019

Sociology Health & Illness

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HIV pre‐exposure prophylaxis (PrEP) has been embraced in Australia, making PrEP available with public funding to people at risk of HIV. Here, we consider the associated ‘problems’ of reduced condom use and sexually transmissible infections (STIs), as seen by HIV professionals. Twenty‐one interviews were conducted during May‐August 2017. All agreed that PrEP was a valuable addition to HIV prevention, but their views about reduced condom use and STIs were variable. Using poststructural policy analysis, three main stances were identified: (1) Concerned/alarmed. PrEP was seen as causing reduced condom use, STIs and antibiotic resistance, posing threats to the general population; (2) Neutral/normalising. Stakeholders emphasised that condom use was declining and STIs increasing independently of PrEP, and that PrEP was simply a new tool to be accommodated; (3) Optimistic/critical. PrEP was seen as diminishing fear of HIV and engaging users in more frequent testing and treatment that could lead to declining STI rates. What linked all three stances was the selective performance of evidence, deploying a mixture of personal experience, clinical observations, behavioural data and epidemiology. Anticipating possible futures through evidence‐making suggested practical, political and moral consequences for what PrEP could become. We encourage others to consider these consequences with care.

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Section: Optimistic/criticalmentioning

confidence: 80%

“…PrEP is positioned here as a way to escape the fear and threat of HIV, as has been observed in other research (Hughes et al . , Koester et al . ).…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…It will continue to evolve through its use in practice, particularly as users adjust to and remake what PrEP is (Holt , Hughes et al . , Koester et al . , Newman et al .…”

Section: Discussionmentioning

confidence: 99%

“…Attending to the ways in which users configure and respond to PrEP and its ‘problems’, as others have done, remains critical (Holt , Hughes et al . , Newman et al . ).…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

HIV pre‐exposure prophylaxis and the ‘problems’ of reduced condom use and sexually transmitted infections in Australia: a critical analysis from an evidence‐making intervention perspective

Holt

Newman

Lancaster

et al. 2019

Sociology Health & Illness

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A Harm-Reduction Approach to Coronavirus Disease 2019 (COVID-19)—Safer Socializing

Kutscher

Greene

2020

JAMA Health Forum

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Spring in Central Park this year looks different. The park is disproportionately full of gay men wearing speedos, tanning, and listening to music. However, this year the blankets between the men are 6 feet apart. Couples share blankets, yet friends remain on their own. Hand sanitizer is next to every picnic arrangement. When a person comes or leaves the park, they wear a facemask. Central Park has become the center of a new type of social interaction: safer socializing.

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Clinical exigencies, psychosocial realities: negotiating HIV pre‐exposure prophylaxis beyond the cascade among gay, bisexual and other men who have sex with men in Canada

et al. 2018

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IntroductionNotwithstanding the efficacy of oral pre‐exposure prophylaxis (PrEP) in clinical trials, a number of obstacles exist to achieving population‐level impact among gay, bisexual and other men who have sex with men (GBM). However, few studies have explored the subjective experiences of GBM PrEP users and non‐users in the community, outside of clinical trials. The objectives of this study were to explore GBM's experiences of considering, accessing and using (or not using) PrEP, and to understand emerging sexual health, social and community issues among GBM in the PrEP era.MethodsFrom October 2015 to March 2016, we purposively sampled PrEP‐naïve and PrEP‐experienced GBM from community organizations and health centres in Toronto, Canada. In‐depth, 45‐ to 90‐minute semi‐structured interviews explored PrEP perspectives and decision‐making, access, initiation, use over time, sexual practices and psychosocial considerations. Interviews were recorded, transcribed verbatim, uploaded into NVIVO, reviewed using thematic analysis and then contrasted with the PrEP cascade.ResultsParticipants included PrEP users (n = 15) and non‐users (n = 14) (mean age = 36.7 years; SD = 8.2), largely gay‐identified (86.2%), cisgender male (89.7%) and white (79.3%). Themes indicate not only correspondences, but also limitations of the PrEP cascade by complicating a user/non‐user binary and challenging the unilateral presupposition that HIV risk perception leads to PrEP acceptance. Findings further call into question assumptions of a linear stage progression and retention in care as a universal endpoint, instead revealing alternate trajectories of seasonal or intermittent PrEP use and, for some, an end goal of terminating PrEP. GBM's narratives also revealed potent psychological/affective experiences of untethering sex from HIV anxiety; multifaceted PrEP stigma; and challenges to sexual norms and practices that complicate existing behavioural prevention strategies and sexual and social relationships.ConclusionsAn expanded PrEP cascade should consider alternate trajectories of use based on dynamic relationships and behavioural risks that may call for seasonal or intermittent use; systemic barriers in access to and sustaining PrEP; and multiple end goals including PrEP maintenance and discontinuation. Incorporating GBM's lived experiences, evolving preferences, and psychosocial and community‐level challenges into PrEP implementation models, rather than a circumscribed biomedical approach, may more effectively support HIV prevention and GBM's broader sexual and psychological health.

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Body/Selves and Beyond: Men’s Narratives of Sexual Behavior on PrEP

Cited by 31 publications

References 43 publications

HIV pre‐exposure prophylaxis and the ‘problems’ of reduced condom use and sexually transmitted infections in Australia: a critical analysis from an evidence‐making intervention perspective

HIV pre‐exposure prophylaxis and the ‘problems’ of reduced condom use and sexually transmitted infections in Australia: a critical analysis from an evidence‐making intervention perspective

A Harm-Reduction Approach to Coronavirus Disease 2019 (COVID-19)—Safer Socializing

Clinical exigencies, psychosocial realities: negotiating HIV pre‐exposure prophylaxis beyond the cascade among gay, bisexual and other men who have sex with men in Canada

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