Taking PrEP improves wellbeing
15 Nov 2023
The benefits of pre-exposure prophylaxis (PrEP) go beyond preventing HIV, according to new research published today in AIDS Research and Therapy. Taking PrEP improves gay men’s wellbeing, leads to more sexual freedom and reduces harmful drug use. However, some users may feel conflicted about PrEP and its disruption of social norms around condom use.
These qualitative findings were collected as part of the PROUD study, which is the first of its kind to assess the psychological and social impacts of taking PrEP among gay men in England.
Psychological and social health problems, such as harmful substance use, depression and anxiety, are prevalent among men who have sex with men. Researchers have attributed this to higher stress levels caused by stigma and discrimination due to their sexuality. Gay and bisexual men are also disproportionately affected by HIV.
PrEP is a type of antiretroviral therapy taken before or during potential exposure to HIV. It offers effective protection against HIV for those who do not use condoms consistently. In the PROUD study, men and transgender women who have sex with men received either an immediate or deferred (after 12 months) offer of a daily oral PrEP tablet called Truvada (TDF/FTC), as part of an overall HIV risk reduction package from sexual health clinics in England. PROUD opened in 2012 and followed some of the earliest users of PrEP in the UK. In 2015, PROUD reported that offering PrEP reduced HIV infections by 86%.
The PROUD team also wanted to explore the impacts of PrEP beyond its primary function of preventing HIV. 41 participants (40 gay men and one trans woman) took part in semi-structured, in-depth interviews about their attitudes towards PrEP and its influence on their self-perception and sexual behaviours.
They found that taking PrEP improves users’ wellbeing by reducing HIV-related anxiety and internalised stigma, as well as increasing feelings of sexual pleasure and intimacy. These psychological changes may then translate into behavioural changes. In some participants, feeling less anxiety around sex led to more sexual freedom, such as having more frequent sex or with more partners. Others reported less harmful drug use and less risky sexual behaviour after starting PrEP.
But some interviewees felt conflicted about having condomless sex while taking PrEP, as they felt condoms were the ‘ideal’ way to avoid acquiring HIV. Others were concerned about stigma and being perceived as engaging in risky sexual behaviour because they were taking PrEP.
These findings provide a baseline for researchers to understand how PrEP affects gay men in England beyond preventing HIV. However, as this research was conducted around 10 years ago among early adopters of PrEP, current users’ attitudes may reflect the fact that PrEP is now much more widespread.
Currently, eligibility for PrEP in the UK is determined by an assessment of HIV risk. The PROUD team hope these findings could inform how policymakers can also consider the potential social and psychological impacts of taking PrEP in future prescribing guidelines.
- PROUD study page
- PROUD trial website
- “Sex without fear”: exploring the psychosocial impact of oral HIV pre-exposure prophylaxis on gay men in England
- PROUD: A video documentary
- PROUD: Voices of the participants