Negotiating risk and social relations in the context of post-exposure prophylaxis for HIV: Narratives of gay men

Abstract

This paper draws on findings from a study to monitor the implementation of non-occupational post-exposure prophylaxis (PEP) in Australia. It focuses on the study's qualitative arm, which explores in-depth details of possible exposures to HIV, participants' understanding of risk and their physical and psychosocial experience of the treatment. Results indicate that, in addition to taking antiretroviral treatment after unsafe sex, PEP requires the negotiation of a multitude of social relations in order to reduce the possibility of HIV infection. For the participants this meant: assessing the risk; engaging their social networks in the search for possible prophylaxis; negotiating with health professionals when deciding whether to take PEP; and negotiating disclosure of PEP and the sexual risk which necessitated it, to people in their social networks. For the participants in this study, PEP did not undermine safe sex messages. It was used as an additional line of defence when condoms and other risk reduction strategies had failed. Participants presented themselves in their narratives in accordance with the public health discourse of safe sex, which foregrounds agency and rational decision making, in relation to all aspects of PEP: sexual practices, treatment decision and disclosure.