Abstract
BackgroundHIV 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.MethodsParticipants 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.ResultsThe 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.ConclusionsThe 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.
Highlights
human immunodeficiency virus (HIV) has affected gay men disproportionately in the U.S for four decades
We sought to build upon the scant information we found about psychological correlates of Pre-exposure prophylaxis (PrEP) use [33], which suggested that subjective factors affect GMSM’s interest in PrEP [18, 36]
The results of our study indicate that, for the participants of our study, there is a specific sense of “what it’s like to be someone who is on PrEP,” a category described by participants that comprised how social and interpersonal factors, including group identification, committed relationships, and sexual partners, have a significant bearing on the motivations to use PrEP and on the sense of whether PrEP is relevant for individuals
Summary
Pre-exposure prophylaxis (PrEP) was developed as a prevention strategy for individuals at high risk of HIV infection. PrEP has not been highly accessed by many populations at high risk of HIV infection including gay and other men who have sex with men (collectively GMSM) [2]. Three prominent areas of PrEP research have focused on PrEP’s medical utility (e.g., side effects and effectiveness), its impact on behaviors such as risk compensation (e.g., how individuals adjust their behavior in relation to their level of perceived risk), and its rates of utilization and uptake. Data from realworld settings, indicate that sexually transmitted infection (STI) diagnoses, condomless anal sex (CAS), and other sexual risk behaviors, are higher among PrEP users [8]. Many researchers contend that the reduction in risk of HIV infection from PrEP use exceeds the increased risk from behavioral changes [9]
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