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The Impact of Pre-Exposure Prophylaxis on Sexual Communication and Sexual Behavior of Urban Gay and Bisexual Men

  • Special Section: Social and Behavioral Science with Gay and Bisexual Men in the Era of Biomedical Prevention
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Abstract

Pre-exposure prophylaxis (PrEP) has altered the public health landscape for gay, bisexual, and other men who have sex with men (GBM) by significantly increasing protection against HIV infection. Early epidemiologic data showed GBM generally used PrEP as prescribed, i.e., as an additional protective tool over and above barrier protection, although subsequent reports have been equivocal. Irrespective of population-level trends, some GBM appear to have reevaluated their HIV risk tolerance and changed their interactions with sex partners. Scant published data have focused on factors that influence PrEP-using GBM’s decisions about sexual behavior—including condom use as well as sex with HIV-positive partners—and sexual communication practices. Thus, in this study, we investigated those research concerns qualitatively via content analysis of individual interviews conducted with 103 GBM in New York City (M age 32.5 years, 50% White, 64% on PrEP > 6 months). Emergent themes reflect (1) participants’ strong HIV knowledge; (2) changing GBM community norms about condom use on PrEP; (3) increased focus on risk tolerance with individual differences in post-PrEP condom use; (4) appreciation for routine sexually transmitted infection (STI) screening in PrEP care concomitant with some STI knowledge deficits; (5) decreased stigma concerning, and greater comfort with, HIV-positive sex partners; and (6) increased confidence discussing HIV status and condom use preferences with partners. Findings have implications for future research as well as for clinical practice, such as enhanced STI education and provider-initiated discussions about risk compensation, serosorting, and sexual communication skills.

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Acknowledgements

PrEP & Me was funded by the National Institute of Drug Abuse (R21 DA 39019, PI: Grov). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH). The authors would like to acknowledge the contributions of other members of the PrEP & Me study team (Mark Pawson, Demetria Cain, Brian Salfas, Chloe Mirzayi, Juan Castiblanco, and Ruben Jimenez), and other staff from the Center for HIV/AIDS Educational Studies and Training (Chris Hietikko, Tina Koo, Desmond Dutcher, and Carlos Ponton). Finally, we thank Shoshana Kahana at NIDA and all of our participants who participated in PrEP & Me. NIDA/NIH had no role in the production of this manuscript nor necessarily endorses its findings. Funding was provided by National Institute on Drug Abuse (Grant No. R21DA39019).

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Authors and Affiliations

  1. Department of Psychology, University of Massachusetts, Boston, MA, 02125, USA

    David W. Pantalone, Alison E. A. Goldblatt, Kaitlyn R. Gorman & Cara Herbitter

  2. The Fenway Institute, Fenway Health, Boston, MA, USA

    David W. Pantalone

  3. Department of Social Welfare, University of California, Los Angeles, CA, USA

    Ian W. Holloway

  4. Department of Community Health and Social Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA

    Christian Grov

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  1. David W. Pantalone
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Pantalone, D.W., Holloway, I.W., Goldblatt, A.E.A. et al. The Impact of Pre-Exposure Prophylaxis on Sexual Communication and Sexual Behavior of Urban Gay and Bisexual Men. Arch Sex Behav 49, 147–160 (2020). https://doi.org/10.1007/s10508-019-01478-z

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