Pre-exposure prophylaxis makes it possible to better live one’s sexuality and guide men who have sex with men towards a responsible approach to their health: a phenomenological qualitative study about primary motivations for PrEP

Abstract

Background Pre-exposure prophylaxis (PrEP) for HIV is instrumental in the prevention of HIV for HIV-uninfected persons, by drastically reducing the risk of acquisition in the case of high-risk exposures. Despite its demonstrated efficacy, it remained under-prescribed in France until 2018. The principal aim of this study was to understand the motivations of Men who have Sex with Men (MSM) who started using PrEP in Montpellier, France. Methods A phenomenological study was undertaken, using semi-structured interviews with twelve participants attending the University Hospital of Montpellier for PrEP. Interviews were analysed by means of triangulation up to the point of theoretical saturation, using a semio-pragmatic method. Results Fear of HIV infection, personalised regular follow-up, and the wish to take care of one’s health were the primary motivational factors. PrEP allows for a better sexual life restoring a sense of freedom despite the risks of STI, deemed manageable by PrEPers. PrEP does not modify long-term risk-taking behaviours but helps them better live their own sexuality and guides them towards a responsible approach to sexuality. Unclear information on PrEP, delivered by their family doctor, public campaigns or the media, leads to misrepresentations or negative social representation, including within the MSM community, which may delay its implementation. Conclusions Fear of HIV infection and the benefits of regular medical follow-up to take care of one’s health were motivational factors of importance for the use of PrEP by MSM in this study. PrEP transforms all existential dimensions of their lived experience, improving sexual identity and happiness. There is a need to improve professional awareness of the effectiveness of PrEP and to develop a patient centered approach, to disseminate information more widely to the general public and among MSM to reduce stigmatisation.

Methodological issues in qualitative research on HIV prevention: an integrative review

“…Other studies investigated care experiences related to preventive methods, including the use and adherence to such methods and patients’ interactions with health professionals and services 12 , 13 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 . We investigated subjects’ experiences with these preventive methods and practices at the interface with different social groups, such as heterosexual men 13 , 36 , 37 , 38 ; men who have sex with men (MSM) 25 , 30 , 39 , 40 , 41 , 42 , 43 ; women 26 , 33 , 44 , 45 , 46 ; African-Americans 21 ; women over 50 years 19 , 24 ; young people (cisgender, transgender, MSM) 16 , 27 , 34 , 35 , 40 , 47 , 48 ; and sex workers 23 , 29 , 45 . Still at the interface with preventive measures, some studies have analyzed issues related to vulnerability 15 , 22 , 49 ; explained risk behavior as the central object for analysis 14 , 31 , 35 , 39 , 42 , 47 , 50 , 51 , 52 ; masculinity 12 ,…”

“…We investigated subjects’ experiences with these preventive methods and practices at the interface with different social groups, such as heterosexual men 13 , 36 , 37 , 38 ; men who have sex with men (MSM) 25 , 30 , 39 , 40 , 41 , 42 , 43 ; women 26 , 33 , 44 , 45 , 46 ; African-Americans 21 ; women over 50 years 19 , 24 ; young people (cisgender, transgender, MSM) 16 , 27 , 34 , 35 , 40 , 47 , 48 ; and sex workers 23 , 29 , 45 . Still at the interface with preventive measures, some studies have analyzed issues related to vulnerability 15 , 22 , 49 ; explained risk behavior as the central object for analysis 14 , 31 , 35 , 39 , 42 , 47 , 50 , 51 , 52 ; masculinity 12 , 27 , 28 , 36 ; gender 22 , 50 and sexuality 16 , 43 , 53 , 54 ; and social support networks 41 .…”

“…Our third dimension of analysis investigated different methodological approaches. Among the articles we selected, some arose from research conceived as exclusively qualitative 12 , 19 , 21 , 22 , 25 , 26 , 33 , 34 , 35 , 36 , 37 , 38 , 43 , 45 , 46 , 47 , 48 , 53 , 54 ; some were based on articles with a mixed design 15 , 16 , 27 , 32 , 41 , 53 ; and some reported having a “qualitative” focus on the “phase” or “component” of broader research 13 , 20 , 24 , 28 , 29 , 30 , 31 , 39 , 40 , 44 , 47 , 52 , such as clinical trials and community-based research.…”

“…As for the explanation of the theoretical anchoring of the different methodological designs, we found studies that were based on ethnography 20 , 39 , 54 ; medical anthropology 19 ; interpretive anthropology 15 ; case study 47 ; phenomenological study 43 ; community-based study 34 ; and the Theory of Social Representations 16 . However, many studies lacked an explanation of the methodological design, citing only the methodological approach and the techniques for production and analysis 12 , 13 , 14 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 35 , 37 , 38 , 40 , 42 , 43 , 44 , 45 , 46 , 48 , 49 , 50 , 52 , 53 .…”

General practitioners must acquire skills to communicate with child with Autism Spectrum Disorder to regain their values and role in the follow-up – phenomenological study

“…of the highest level in the hierarchy of signs) commands the meaning of the phenomenon at play [ 21 ]. Table 3 summarises the steps of the method used [ 22 ].…”