What does PrEP mean for 'safe sex' norms? A qualitative study

PLoS One. 2021 Aug 5;16(8):e0255731. doi: 10.1371/journal.pone.0255731. eCollection 2021.

Abstract

While HIV pre-exposure prophylaxis (PrEP) is highly effective, it has arguably disrupted norms of 'safe sex' that for many years were synonymous with condom use. This qualitative study explored the culture of PrEP adoption and evolving concepts of 'safe sex' in Sydney, Australia, during a period of rapidly escalating access from 2015-2018, drawing on interviews with sexually active gay men (n = 31) and interviews and focus groups with key stakeholders (n = 10). Data were analysed thematically. Our results explored the decreasing centrality of condoms in risk reduction and new patterns of sexual negotiation. With regards to stigma, we found that there was arguably more stigma related to not taking PrEP than to taking PrEP in this sample. We also found that participants remained highly engaged with promoting the wellbeing of their communities through activities as seemingly disparate as regular STI testing, promotion of PrEP in their social circles, and contribution to research. This study has important implications for health promotion. It demonstrates how constructing PrEP as a rigid new standard to which gay men 'should' adhere can alienate some men and potentially create community divisions. Instead, we recommend promoting choice from a range of HIV prevention options that have both high efficacy and high acceptability.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attitude to Health*
  • HIV Infections / prevention & control*
  • HIV Infections / psychology
  • Humans
  • Male
  • Middle Aged
  • Pre-Exposure Prophylaxis / methods*
  • Safe Sex / psychology*
  • Sexual and Gender Minorities / psychology

Grants and funding

This study was funded using Bridget Haire's fellowship funding from the NHMRC, RG150825.