The relevance of pre-exposure prophylaxis in gay men’s lives and their motivations to use it: a qualitative study

Abstract

Background HIV has affected gay men disproportionately in the U.S. for four decades. Pre-exposure prophylaxis (PrEP) was developed as a prevention strategy for individuals at high risk of HIV infection. Although highly effective, many gay and other men who have sex with men continue not to take PrEP. Researchers have focused on sexual risk behaviors as the primary determinant of who should be on PrEP and identified various objective systemic and societal barriers to PrEP access. Public health measures have promoted PrEP based on these objective criteria. Researchers have recently begun to inquire into subjective and relational motivators for PrEP usage beyond self-perceived risk. Methods Participants were recruited through snowball sampling. Data were collected between August and November 2018 from PrEP users (n = 7) and PrEP non-users (n = 6). Data were analyzed in a modified grounded theory qualitative analysis. Results The thirteen participants’ narratives contained three superordinate categories: (1) what it’s like to be someone on PrEP, (2) an environment of changing sexual norms, and (3) the continued importance of education. These categories comprised ten themes, each of which had various repeating ideas. The ten themes were the following: (1) PrEP’s social acceptability, (2) PrEP and HIV stigma, (3) PrEP and sexual relationships, (4) dissatisfaction with condoms, (5) negotiating risk, (6) peace of mind, (7) developing a relationship with PrEP, (8) putting yourself first, (9) PrEP awareness, and (10) PrEP logistics. Conclusions The gay men in our study took into consideration their social roles and relationships, their personal beliefs, and emotional histories as well as risk as prominent motivators for PrEP use. They stated that PrEP use is associated with their sense of belonging, trust, and security about their sexuality. They also identified the most relevant aspects of the medication (e.g., side effects, adherence, and awareness) to their lives.

Holistic Sexual-Reproductive Healthcare Services and Needs for Queer Individuals: Healthcare Providers’ Perspectives

“…Our findings support the importance of the study by Dorcé-Medard et al [46] which finds that PrEP is critical for limiting HIV transmission among the LGBTQ+ subgroup. Furthermore, our findings support and agree with the findings of Alcantar-Heredia et al [47] that PrEP use is associated with a sense of belonging, trust, and security about their sexuality, as well as another study by Quinn et al [48] that discovered four unexpected benefits of PrEP for young Black men who have sex with men (MSM): improved engagement in medical care, decreased sexual and HIV anxiety, raised sexual comfort and freedom, and positive sexual relationships with individuals living with HIV. Despite the importance and benefits of PrEP, HIV testing, and prevention among LGBT people, other studies have revealed challenges to SRH access in this location, such as transportation, a lack of medical insurance, and the expense of treatments or obtaining services without parental knowledge [49].…”

Examining the secondary impacts of the COVID-19 pandemic on syndemic production and PrEP use among gay, bisexual and other men who have sex with men (GBM) in Vancouver, Canada

“…Importantly, we also found that GBM who met PrEP eligibility criteria at their study visit were less likely to interrupt PrEP compared to GBM who did not meet eligibility. This finding indicates that GBM who were most at risk for HIV were less likely to interrupt treatment, suggesting that GBM who engage in behaviours that place them at greater risk for HIV may understand the benefits of using PrEP and of continuing PrEP as an HIV prevention strategy [ 51 ].…”

Cancer in people who identify as lesbian, gay, bisexual, transgender, queer, or gender‐nonconforming

“…A nationally representative survey reported that only 7.8% of gay and bisexual men took pre-exposure prophylaxis as of 2018, likely because of factors such as low awareness and lack of access. 67,68 Once infection has occurred, highly active antiretroviral therapy suppresses HIV replication and can prevent or delay progression to AIDS and transmission to other individuals. 69 The widespread uptake of highly active antiretroviral therapy in the United…”