“What other choices might I have made?”: Sexual Minority Men, the PrEP Cascade and the Shifting Subjective Dimensions of HIV Risk

Abstract

The PrEP Cascade is a dominant framework for investigating barriers to HIV pre-exposure prophylaxis (PrEP), an HIV prevention tool. We interviewed 37 PrEP users and 8 non-PrEP users in Ontario and British Columbia, Canada, about their decision-making through the Cascade. Participants were HIV-negative gay, bisexual, and queer men (GBQM). The data were analyzed using thematic analysis. PrEP decision-making was based on pragmatic considerations (logistics, costs, and systemic barriers), biomedical considerations (efficacy, side-effects, and sexually transmitted infections), and subjective considerations (identity, politics, and changing sexual preferences). Affective attachments to established versions of “safer sex” (condoms and serosorting) made some GBQM less likely to try PrEP. Some GBQM expressed increased social expectations to use PrEP, have condomless sex, and serodifferent sex. These findings support offering PrEP at no-cost, offering individualized counseling and community-based opportunities to discuss PrEP use and changing sexual practices, and improving communication on the manageability of PrEP side-effects.

Recent Topics Related to Human Sexual Practices - Sexual Practices and Sexual Crimes

“…Two aspects were paramount for me. First, gay men experienced the HIV/AIDS epidemic in the "'80s-'90s (not that HIV/AIDS is over in the world, but those interviewed individuals may have belonged to a generation that has missed seeing or knowing stories of people who died at the beginning of the HIV/ AIDS) However, the second aspect is that all the GLIM participants were very foremost aware of HIV/AIDS and knew about the basic sexual health knowledge on how to prevent getting infected, or if they were HIV positive, they had knowledge about how to avoid spreading it out the virus to others [1,8,11,42,54,[61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77].…”

“…How did COVID-19 affect your health and sexual health practices? (Probing for having only sex with current partner/monogamy, fuckbuddies, bubble's strategies, stopped having sex, requesting for vaccination proof, other) 3 [59,67,71,72,[78][79][80][81][82][83][84][85].…”

“…But I would say that it was primarily with these two people… Although Adrian agreed to have some 'exclusivity contract' with those people, he says he had sex with others outside the bubble he formed. It can be assumed that many people had similar agreements [11,54,72,73,75,77]. Some were respected and followed 100%, while others were hard to follow.…”

Population‐level effectiveness of pre‐exposure prophylaxis for HIV prevention among men who have sex with men in Montréal (Canada): a modelling study of surveillance and survey data

“…In Montréal, despite modest coverage, PrEP had a notable impact on HIV transmission, complementing declining incidence and high ART coverage. Free PrEP could remove important barriers, but more needs to be done to address stigma, discrimination and certain physicians' reticence to prescribe PrEP, among others [44][45][46][47][48][49][50]. The availability of alternative formulations like long-acting injectable PrEP could further usage and support adherence [50].…”

Mapping out COVID-19, Social Distancing, Pandemic in Juxtaposition with Sexual Desires Practices in a Gay Latino Immigrants Men [GLIM] Study

“…Two aspects were paramount for me. First, gay men experienced the HIV/AIDS epidemic in the "'80s-'90s (not that HIV/AIDS is over in the world, but those interviewed individuals may have belonged to a generation that has missed seeing or knowing stories of people who died at the beginning of the HIV/ AIDS) However, the second aspect is that all the GLIM participants were very foremost aware of HIV/AIDS and knew about the basic sexual health knowledge on how to prevent getting infected, or if they were HIV positive, they had knowledge about how to avoid spreading it out the virus to others [1,8,11,42,54,[61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77].…”