Abstract
BackgroundPre-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.MethodsA 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.ResultsFear 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.ConclusionsFear 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.
Highlights
Pre-exposure prophylaxis (PrEP) for Human Immunodeficiency Virus (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
The incidence of HIV is high among men who have sex with men (MSM) and this is the group at highest risk of acquiring the infection [3]
Several questions were raised from the 2012 International Symposium on HIV & Emerging Infectious Diseases (ISHEID) [14]: is high adherence for daily PrEP achievable? Is there a risk of change in behavior that could offset the benefit of PrEP?
Summary
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. The incidence of HIV is high among men who have sex with men (MSM) and this is the group at highest risk of acquiring the infection [3]. Pre-exposure prophylaxis for HIV (PrEP) is a biomedical intervention to prevent HIV infection, available in the United States since 2012 [4] and in France since 2016 [5]. It is aimed at individuals not infected by HIV, in order to reduce the risk of infection in case of high risk sexual practices. Several questions were raised from the 2012 International Symposium on HIV & Emerging Infectious Diseases (ISHEID) [14]: is high adherence for daily PrEP achievable? Is there a risk of change in behavior that could offset the benefit of PrEP?
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