Abstract
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.
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Acknowledgements
We thank all AMPrEP participants and the members of the advisory board and the community engagement group of AMPrEP. We further acknowledge the following persons for their invaluable support to this study: Sanne Eekman, Gerard Sonder, Yvonne van Duijnhoven, Gerben Rienk Visser, Linda May, Paul Oostvogel, Sylvia Bruisten, Anders Boyd, Adriaan Tempert, Kees de Jong, Ilya Peters, Myra van Leeuwen, Princella Felipa, and Lucy Phillips, and all of those who contributed to the H-TEAM (see Supplement 2).
Funding
The AMPrEP project has received funding as part of the H-TEAM initiative from ZonMw (Grant Number: 522002003), the National Institute for Public Health and the Environment and GGD research funds. The study drug is provided by Gilead Sciences. The H-TEAM initiative is being supported by the Aidsfonds Netherlands (Grant Number: 2013169), Stichting Amsterdam Diner Foundation, Gilead Sciences Europe Ltd (Grant Number: PA-HIV-PREP-16-0024), Gilead Sciences (Protocol Numbers: CO-NL-276-4222, CO-US-276-1712), Janssen Pharmaceuticals (Reference Number: PHNL/JAN/0714/0005b/1912fde), M.A.C AIDS Fund, and ViiV Healthcare (PO Numbers: 3000268822, 3000747780).
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HMLZ, EH, RCAA, and UD contributed to study concept and design. HMLZ, LRP, RCAA, TR, EH, and UD contributed to acquisition, analysis, or interpretation of the data. HMLZ drafted the article. All authors critically revised and approved the final version for publication. EH, MP, MFSvdL, HJCdV and UD obtained funding.
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Our institute received the drugs for the Amsterdam PrEP study from Gilead Sciences based on an unconditional grant. E.H. received financial reimbursement for time spent serving on advisory boards of Gilead Sciences and a speaker fee from Janssen-Cilag, paid to her institute. M.P. obtained unrestricted research grants and speaker’s fees from Gilead Sciences, Roche, Abbvie, and MSD, paid to her institute. U.D. obtained unrestricted research grants and speaker’s fees from Gilead Sciences paid to his institute. The remaining authors declared no potential conflicts of interests for this project.
Ethical Approval
The AMPrEP protocol obtained medical approval from the ethics board of the Amsterdam UMC at the Academic Medical Center, Amsterdam, the Netherlands (NL49504.018.14). All AMPrEP participants provided written informed consent for the AMPrEP study, which included consent to be approached for interview requests. Participation in interviews for the present study was completely voluntary, and additional oralinformed consent for the recording, storage, and usage of interviews was obtained from all interviewees. The collected data were anonymize. Personal identiiers were deleted from the transcript, and only the researchers had access to anonymize transcripts.
Informed Consent
All AMPrEP participants provided written informed consent for the AMPrEP study, which included consent to be approached for interview requests. Participation in interviews for the present study was completely voluntary, and additional oral informed consent for the recording, storage and usage of interviews was obtained from all interviewees. The collected data were anonymized. Personal identifiers were deleted from the transcript, and only the researchers had access to anonymized transcripts.
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Zimmermann, H.M.L., Postma, L.R., Achterbergh, R.C.A. et al. The Impact of Pre-exposure Prophylaxis on Sexual Well-Being Among Men Who Have Sex with Men. Arch Sex Behav 50, 1829–1841 (2021). https://doi.org/10.1007/s10508-020-01833-5
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DOI: https://doi.org/10.1007/s10508-020-01833-5