The social meanings of PrEP use – A mixed‐method study of PrEP use disclosure in Antwerp and Amsterdam

Abstract

Pre‐Exposure Prophylaxis (PrEP) is a novel HIV prevention tool. PrEP stigma is a frequently reported barrier, while social disclosure of PrEP use may be an important facilitator. We explored how PrEP users managed PrEP use disclosure using a symbolic interactionist approach. We interviewed 32 participants from two PrEP demonstration projects (Be‐PrEP‐ared, Antwerp; AMPrEP, Amsterdam). We validated qualitative findings through Be‐PrEP‐ared questionnaire data. A minority of participants had received negative reactions on PrEP. The way PrEP use was disclosed was highly dependent on the social situation. In a sexual context among MSM, PrEP use was associated with condomless sex. Friends endorsed PrEP use as a healthy choice, but also related it to carelessness and promiscuity. It was seldom disclosed to colleagues and family, which is mostly related to social norms dictating when it is acceptable to talk about sex. The study findings reveal that PrEP stigma experiences were not frequent in this population, and that PrEP users actively manage disclosure of their PrEP user status. Frequent disclosure and increased use may have helped PrEP becoming normalised in these MSM communities. To increase uptake, peer communication, community activism and framing PrEP as health promotion rather than a risk‐reduction intervention may be crucial.

Strategies to improve PrEP uptake among West African men who have sex with men: a multi-country qualitative study

“…To overcome such barriers, participants proposed to normalize PrEP by making it available to the wider public and to underscore its protective effect. As suggested elsewhere, moving away from a risk-based narrative toward a health-promotion approach may be a more convincing narrative to increase PrEP demand ( 38 , 42 , 43 ). Novel long-acting HIV prevention tools such as injectable PrEP may be very promising in these communities, as they are more discrete and could reduce the risk of stigmatization upon involuntary disclosure of their sexual orientation ( 44 ).…”

“…This finding corroborates quantitative studies, indicating that oral PrEP awareness in these communities may already have increased ( 36 , 37 ). Stimulating peer communication and supporting PrEP users in actively disclosing their PrEP status to other community members can be important strategies for increasing its uptake ( 38 ). Moreover, community outreach may be crucial to increasing the uptake of HIV prevention services such as PrEP and HIV testing among those not-yet-reached by local clinics or gay community organizations ( 23 , 39 , 40 ).…”

Psychometric Properties of an Adapted Stigma Scale and Experiences of Stigma Associated with HIV Pre-exposure Prophylaxis Use Among Men Who have Sex with Men: A Mixed Methods Study

“…Discussing PrEP use outside of sexual relationships was a topic highlighted directly and indirectly in our qualitative and quantitative work respectively. This may reflect social norms related to when it is deemed appropriate to talk about sex, as highlighted from work conducted with PrEP users in Antwerp and Amsterdam [ 41 ]. The implicit assumption that a PrEP user is gay, and the concerns associated with this assumption, is a finding highlighted in a meta-ethnography by Edeza et al [ 9 ].…”

Multifaceted Barriers to Rapid Roll-out of HIV Pre-exposure Prophylaxis in China: A Qualitative Study Among Men Who Have Sex with Men

“…This mirrors previous survey studies reporting factors associated with PrEP uptake in Chinese and other cultural contexts [ 17 , 18 , 30 , 31 ]. The policy and official communication vacuum before the official approval of PrEP in August 2020 likely fostered the spread of myths and stigmatizing information (e.g., PrEP association with risky sex and promiscuity) [ 32 ] and left people skeptical about PrEP [ 33 , 34 ]. Our findings provide a strong rationale for promoting PrEP for all populations at risk of HIV and non-discriminatory PrEP advocacy strategies in China, where HIV stigma is interwoven with stigma toward sexual minority groups.…”