Pre-exposure prophylaxis (PrEP) is a promising strategy to reduce HIV incidence among men who have sex with men (MSM). How and when PrEP is used could in part be influenced by its impact on the sexual well-being of its users. Yet, the impact of PrEP on sexual well-being has received little attention in current literature and is not well-understood. We conducted 43 in-depth interviews (June 2017–June 2018) with HIV-negative MSM who started PrEP within the Amsterdam PrEP study. We used purposive sampling to select participants who (1) reported changes on well-being indicators; (2) switched between PrEP-dosing regimens; (3) neither changed regimens nor changed on well-being indicators. Transcribed interviews were qualitatively analyzed by means of an open-coding process. Results showed that PrEP minimized HIV-related fear, increased self-esteem, and reduced stigma and shame about having condomless anal sex. The psychological relief provided by PrEP also enabled relaxation which reduced pain during anal sex. PrEP use increased the diversity of partner choices and improved the perceived quality of sexual relationships and the ability to develop relationships. Along with this positive impact, almost half of interviewees reported concurrent negative experiences. In some cases, PrEP triggered more extreme sexual behaviors and/or problematic increases in preoccupation with sex and drug use. These were perceived as having a negative impact on sexual relationships, sexual well-being, PrEP adherence, and general health. In conclusion, our findings suggest that PrEP contributes to improvements in sexual well-being that go beyond protection from HIV. Counseling strategies should be devised to help PrEP users mitigate possible co-existing negative consequences of PrEP use.

暴露前预防 (PrEP) 是降低男男性行为者 (MSM) 中 HIV 发病率的一种很有前景的策略。PrEP 的使用方式和时间在一定程度上可能会受到其对使用者性福祉的影响。然而，PrEP 对性健康的影响在当前文献中很少受到关注，也没有得到很好的理解。我们对在阿姆斯特丹 PrEP 研究中开始 PrEP 的 HIV 阴性 MSM 进行了 43 次深度访谈（2017 年 6 月至 2018 年 6 月）。我们使用有目的的抽样来选择 (1) 报告幸福指标变化的参与者；(2) 在 PrEP 给药方案之间切换；(3)既没有改变治疗方案，也没有改变幸福指数。通过开放编码过程对转录的访谈进行定性分析。结果表明，PrEP 最大限度地减少了与 HIV 相关的恐惧，增加了自尊，并减少对无安全套肛交的耻辱和耻辱。PrEP 提供的心理缓解还可以放松，从而减轻肛交时的疼痛。PrEP 的使用增加了伴侣选择的多样性，并提高了性关系的感知质量和发展关系的能力。除了这种积极影响之外，几乎一半的受访者还报告了同时存在的负面经历。在某些情况下，PrEP 引发了更极端的性行为和/或对性和药物使用的关注增加。这些被认为对性关系、性福祉、PrEP 依从性和一般健康产生负面影响。总之，我们的研究结果表明，PrEP 有助于改善性福祉，而不仅仅是保护免受 HIV 感染。