Pleasure and PrEP: Pleasure-Seeking Plays a Role in Prevention Choices and Could Lead to PrEP Initiation

Abstract

Pleasure-seeking plays a role in prevention (means choices and use), and in the sexual quality of life of men who have sex with men (MSM). Since HIV is a major threat to MSM health, new means of prevention, like pre-exposure prophylaxis (PrEP), must meet the needs of MSM to be fully efficient. Using a psychosocial approach, we examined how pleasure-seeking plays a role in participation of MSM in “ANRS-IPERGAY,” a community-based trial on sexual health which included sexual on-demand PrEP. Thirteen semistructured collective interviews were conducted with 45 participants. First, we analyzed participants’ search for new prevention means due to previous failures in condom use. We found that participants perceived condoms as a barrier—both materially and symbolically—to pleasure and desire, causing anxiety and stress considering sexual intercourse. Second, we explored representations and attitudes concerning pleasure within the context of PrEP. We found that PrEP allowed participants to freely choose their desired sexual positions and to better enjoy intimacy. Third, we studied the sexual quality of life for PrEP users in ANRS-IPERGAY and found an improvement. Thanks to the community-based design of the trial, this new prevention tool became a means to develop agency and empowerment for participants, not only in negotiating individual prevention but also in opposing the normative and stigmatizing discourse on sexuality and HIV. In conclusion, pleasure-seeking appears to be an essential element of sexual fulfillment that needs to be integrated as a positive notion in the study of HIV prevention.

Socio-Sexual Experiences and Access to Healthcare Among Informal PrEP Users in the Netherlands

“…It often played a role in participants' considerations on how PrEP increased the quality of their sex life, as PrEP use helped participants to explore ways of having sex, for example by switching sexual positions (insertive/receptive) or by experimenting with substance use and participating in sex parties. This is in line with findings from other countries and in earlier studies [17,27,50,64], and seems to reflect an overall trend, regardless of whether the type of procurement and use is informal or formal. Participants noted that the reduced fear for HIV felt liberating and improved their sex life.…”

What are the situational and behavioral factors associated with condomless anal sex without pre-exposure prophylaxis in MSM?

“…The main reported barriers to condom use in MSM are the loss of pleasure (2)(3)(4) and the lack of intimacy with the partner (5)(6)(7).…”

“It’s hard for us men to go to the clinic. We naturally have a fear of hospitals.” Men’s risk perceptions, experiences and program preferences for PrEP: A mixed methods study in Eswatini

“…The forgoing of condoms by about half of the male PrEP initiators interviewed needs to be seen in relation to condom use prior to PrEP use, which may not have been consistent, as the British PROUD study documented for MSM [ 74 ]. A recent MSM study among IPERGAY participants described MSM’s experience of more pleasurable and serene sexual intercourse as they did not have to deal with the material barrier of a condom or the anxiety of putting it on correctly while interrupting intercourse [ 75 ]. Some MSW in Eswatini shared these sentiments and even hoped that PrEP might increase libido, yet their response also included concerns that PrEP may lead to erectile or relationship problems.…”