ABSTRACT

In 2012, the U.S. FDA approved the first drug for use as HIV Pre-Exposure Prophylaxis (PrEP), which is nearly 99% effective when taken as prescribed. Although the manifest function of PrEP is to prevent HIV infection in the event of exposure, the drug has also had a significant impact on various facets of sexuality. In this review, we focus on research that emerged in the near decade since PrEP’s approval, with a specific focus on the ways in which different elements of sex and sexuality have been impacted by gay, bisexual, and other men who have sex with men (GBMSM), cisgender women, and transgender individuals. We highlight evidence showing how PrEP has enhanced sexual self-esteem, improved sexual pleasure, reduced sexual anxiety, and has increased sexual agency for those taking it. For many, PrEP also serves as a gateway to improve routine health and increase sexual health-care utilization. Additionally, we review the question of whether PrEP is associated with increased sexual risk taking (i.e. risk compensation), and note that, although some data are mixed, PrEP is not intended as an intervention to reduce condomless anal sex or STIs: it aims to prevent HIV. Finally, our review highlights that, although the volume of research on PrEP among GBMSM is robust, it is underdeveloped for cisgender women and transgender populations and insufficient for inclusion in such a review for cisgender heterosexual men was. PrEP research with these populations is an important direction for future research. Finally, from 2012 to 2019, a single PrEP formulation and delivery method was FDA approved (oral emtricitabine/tenofovir disoproxil fumarate). As additional drug formulations (ie.g., emtricitabine/tenofovir alafenamide) and delivery methods (e.g., microbiocides, vaginal ring, injectable) come to market, it will be important to examine how these, too, impact the spectrum of sexuality.

摘要

2012 年，美国 FDA 批准了第一种用作 HIV 暴露前预防 (PrEP) 的药物，按处方服用有近 99% 的有效性。尽管 PrEP 的明显功能是在暴露时预防 HIV 感染，但该药物也对性行为的各个方面产生了重大影响。在这篇综述中，我们关注自 PrEP 批准以来近十年内出现的研究，特别关注同性恋、双性恋和其他男男性行为者对性和性行为的不同元素的影响方式（ GBMSM）、顺性别女性和跨性别者。我们强调证据表明 PrEP 如何增强性自尊、改善性快感、减少性焦虑，并增加服用者的性能力。对于很多，PrEP 还可以作为改善日常健康和提高性保健利用率的途径。此外，我们回顾了 PrEP 是否与性风险增加（即风险补偿）相关的问题，并注意到，尽管一些数据是混合的，但 PrEP 并不是为了减少无避孕套肛交或性传播感染的干预措施：它旨在预防艾滋病毒。最后，我们的审查强调，尽管 GBMSM 中关于 PrEP 的研究数量很大，但针对顺性别女性和跨性别人群的研究尚不完善，并且不足以纳入此类针对顺性别异性恋男性的审查。对这些人群进行 PrEP 研究是未来研究的重要方向。最后，从 2012 年到 2019 年，单一的 PrEP 制剂和给药方法获得 FDA 批准（口服恩曲他滨/富马酸替诺福韦二吡呋酯）。