How Male Sex Workers and Their Clients Shifted from Reluctance About HIV Pre-exposure Prophylaxis to Advocating for Its Use: A Longitudinal Mixed Methods Study

  • James MacGibbonEmail author
  • Victor Minichiello
  • Garrett Prestage
  • Stephen Bell
  • Cameron Cox
  • Basil Donovan
  • Denton Callander
Original Paper


We assessed individual and collective responses to HIV pre-exposure prophylaxis (‘PrEP’) among a network of male sex workers and clients. From 2011 to May 2017, keyword searches on an online discussion forum identified 668 posts that referenced PrEP. We conducted four analyses: (i) discourse analysis identifying reactions to PrEP, (ii) thematic analysis constructing rhetorical strategies, (iii) content analysis comparing discursive positions and rhetorical strategies, and (iv) longitudinal analyses assessing trends over time. Forum posts adopted one of three discursive positions (reluctance, interest, advocacy), drawing upon four non-exclusive strategies (deference to experts and evidence, acknowledging personal and shared experiences, establishing philosophical arguments, engaging in speculation). Posts from sex workers were more likely than clients to be supportive of PrEP (96% vs. 42%; χ2 = 18.46, p < 0.001) while over time this network moved from being predominantly reluctant about PrEP (61% of posts in 2012) to advocating for its use (65% of posts in 2017; Z = 5.01, p < 0.001).


HIV prevention Biomedical technologies Male sex work Gay and bisexual men Safer sex norms 


Evaluamos las respuestas individuales y colectivas a la profilaxis pre-exposición para el VIH (el “PrEP” en Inglés) entre una red de trabajadores sexuales masculinos y de clientes. Desde 2011 hasta mayo de 2017, las búsquedas de palabras claves en un foro de discusión en línea identificaron 668 publicaciones que se refirieron al PrEP. Realizamos cuatro análisis: (i) análisis del discurso identificando las reacciones al PrEP, (ii) análisis temático construyendo estrategias retóricas, (iii) análisis de contenido comparando posiciones discursivas y estrategias retóricas, y (iv) análisis longitudinal evaluando tendencias sobre el tiempo. Los mensajes del foro adoptaron una de tres posiciones discursivas (reluctancia, interés, abogacía), basándose en cuatro estrategias no exclusivas (deferencia a los expertos y evidencia, reconociendo experiencias personales y compartidas, estableciendo argumentos filosóficos, participando en especulaciones). Los mensajes del foro de los trabajadores sexuales eran más propensos que los clientes a apoyar el PrEP (96% frente a 42%; χ2 = 18.46, p < 0.001), mientras que sobre este tiempo esta red pasó de ser predominantemente reticente al PrEP (61% de los mensajes del foro en 2012) a abogando por su uso (65% de los mensajes del foro en 2017; Z = 5.01, p < 0.001).



This research was funded by a grant from the Australian Research Council (DP170104575) with support from the Scarlet Alliance and the New South Wales Sex Workers Outreach Project. The funding source did not have any involvement in the collection, analysis and interpretation of data, or in the writing of this manuscript and decision to submit for publication.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Kirby InstituteUNSW SydneyKensingtonAustralia
  2. 2.Centre for Social Research in HealthUNSW SydneyKensingtonAustralia
  3. 3.Australian Research Centre in Sex, Health and SocietyLa Trobe UniversityBundooraAustralia
  4. 4.School of Medicine and Public HealthUniversity of NewcastleCallaghanAustralia
  5. 5.Faculty of Law, School of JusticeQueensland University of TechnologyBrisbaneAustralia
  6. 6.Sex Workers Outreach Project IncSurry HillsAustralia
  7. 7.Sydney Sexual Health Centre, Sydney HospitalSydneyAustralia
  8. 8.Spatial Epidemiology LabNew York UniversityNew YorkUSA

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