We report on Australian gay and bisexual men’s (GBM) perceptions of preexposure prophylaxis (PrEP). Drawing on an online longitudinal cohort study, 1,404 free-text responses from HIV-negative or untested Australian GBM were qualitatively analysed. The chi-square statistic was then used to assess differences regarding PrEP-perceptions by participants’ demographic and behavioral characteristics. Positive views of PrEP were twice more common than negative. Those with positive views thought PrEP helped overcome HIV fear and anxiety, enhanced sexual pleasure, and was a ‘socially responsible’ course of action. Those with negative views believed that people without medical conditions did not need medication and expressed concern that PrEP was replacing condoms, representing ‘dangerous’ behavior. Descriptive statistics revealed differences in PrEP-perceptions relating to age, recency of HIV testing, and PrEP eligibility. This study is the first to use free-text data to examine the frequency of Australian GBM’s PrEP-perceptions, highlighting the potential benefits and challenges to its promotion.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Fonner VA, Dalflish SL, Kennedy CE, et al. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS. 2016;30(12):1973–83.
World Health Organisation. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Geneva, Switzerland: World Health Organisation; 2016.
Ryan KE, Mak A, Stoove M, et al. Protocol for an HIV pre-exposure prophylaxis (PrEP) population level intervention study in Victoria Australia: the PrEPX study. Front Public Health. 2018;6:151.
Zablotska IB, Selvey C, Guy R, et al. Expanded HIV pre-exposure prophylaxis (PrEP) implementation in communities in New South Wales, Australia (EPIC-NSW): design of an open label, single arm implementation trial. BMC Public Health. 2018;18(1):210.
AIDS Council of New South Wales (ACON). How much does PrEP cost? Available from: https://endinghiv.org.au/blog/how-much-does-prep-cost/# Accessed 2 Dec 2019
Holt M, Lea T, Kippax S, et al. Awareness and knowledge of HIV pre-exposure prophylaxis among Australian gay and bisexual men: results of a national, online survey. Sex Health. 2016;13(4):359–65.
Institute K. HIV, Viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2018. Sydney, NSW: Kirby Institute, UNSW Sydney; 2018.
Holt M, Lea T, Mao L, et al. Community-level changes in condom use and uptake of HIV pre-exposure prophylaxis by gay and bisexual men in Melbourne and Sydney, Australia: results of repeated behavioral surveillance in 2013–17. Lancet HIV. 2018;5(8):e448–e456.
Hunt G. New Medicine to Help End the transmission of HIV. Somerville, Victoria; 2018. Available from: https://www.greghunt.com.au/new-medicine-to-help-end-the-transmission-of-hiv/ Accessed 12 Mar 2019.
Zablotska IB, Gray R, Whittaker B, et al. The estimated number of potential PrEP users among gay-identifying men who have sex with men in Australia. PLoS ONE. 2018;13(10):e0204138.
Wright E, Grulich A, Roy K, et al. Australasian society for HIV, viral hepatitis and sexual health medicine HIV pre-exposure prophylaxis: clinical guidelines. J Virus Erad. 2018;4(2):143.
PrEP Watch. Country Updates. Available from: https://www.prepwatch.org/in-practice/country-updates/ Accessed 2 Dec 2019.
To KW, Lee SS. HIV pre-exposure prophylaxis in South East Asia: a focused review on present situation. Intl J Infect Dis. 2018;77:113–7.
Zablotska I, Grulich AE, Phanuphak N, et al. PrEP implementation in the Asia-Pacific region: opportunities, implementation and barriers. J Intl AIDS Soc. 2016;19(7):21119.
Bourne A, Alba B, Garner A, et al. Use of, and likelihood of using, HIV pre-exposure prophylaxis among men who have sex with men in Europe and Central Asia: findings from a 2017 large geosocial networking application survey. Sex Trans Infect. 2019;95(3):187–92.
Hayes R, Schmidt AJ, Pharris A, et al. Estimating the ‘PrEP Gap’: how implementation and access to PrEP differ between countries in Europe and Central Asia in 2019. Euro Surveill. 2019;24(41):1900598.
UNITAID. Thirteen countries from Asia and the Pacific plan scale up of PrEP and HIV self-testing. Available from: https://unitaid.org/news-blog/thirteen-countries-from-asia-and-the-pacific-plan-scale-up-of-prep-and-hiv-self-testing/#en Accessed 2 Dec 2019.
Holloway IW, Tan D, Gildner JL, et al. Facilitators and barriers to pre-exposure prophylaxis willingness among young men who have sex with men who use geosocial networking applications in California. AIDS Patient Care STDs. 2017;31(12):517–27.
Holt M. HIV pre-exposure prophylaxis and treatment as prevention: a review of awareness and acceptability among men who have sex with men in the Asia-Pacific region and the Americas. Sex Health. 2014;11(2):166–70.
Kesler MA, Kaul R, Myers T, et al. Perceived HIV risk, actual sexual HIV risk and willingness to take pre-exposure prophylaxis among men who have sex with men in Toronto, Canada. AIDS Care. 2016;28(11):1378–85.
Peng P, Su S, Fairley CK, et al. A global estimate of the acceptability of pre-exposure prophylaxis for HIV among men who have sex with men: a systematic review and meta-analysis. AIDS Behav. 2018;22(4):1063–74.
Pérez-Figueroa RE, Kapadia F, Barton SC, Eddy JA, Halkitis PN. Acceptability of PrEP uptake among racially/ethnically diverse young men who have sex with men: the P18 study. AIDS Educ Prev. 2015;27(2):112–25.
Thomann M, Grosso A, Zapata R, Chiasson MA. ‘WTF is PrEP?’: attitudes towards pre-exposure prophylaxis among men who have sex with men and transgender women in New York City. Cult Health Sex. 2018;20(7):772–86.
Vaccher SJ, Kaldor JM, Callander D, Zablotska IB, Haire B. Qualitative insights into adherence to HIV pre-exposure prophylaxis (PrEP) among Australian gay and bisexual men. AIDS Patient Care STDs. 2018;32(12):519–28.
Yi S, Tuot S, Mwai GW, et al. Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low-and middle-income countries: a systematic review and meta-analysis. J Int AIDS Soc. 2017;20(1):21580.
Young I, Flowers P, McDaid LM. Barriers to uptake and use of pre-exposure prophylaxis (PrEP) among communities most affected by HIV in the UK: findings from a qualitative study in Scotland. BMJ Open. 2014;4(11):e005717.
Young I, McDaid L. How acceptable are antiretrovirals for the prevention of sexually transmitted HIV? A review of research on the acceptability of oral pre-exposure prophylaxis and treatment as prevention. AIDS Behav. 2014;18(2):195–216.
Rich JL, Chojenta C, Loxton D. Quality, rigour and usefulness of free-text comments collected by a large population based longitudinal study-ALSWH. PLoS ONE. 2013;8(7):e68832.
Decorte T, Malm A, Sznitman SR, et al. The challenges and benefits of analyzing feedback comments in surveys: lessons from a cross-national online survey of small-scale cannabis growers. Methodol Innov. 2019;12(1):2059799119825606. https://doi.org/10.1177/2059799119825606.
Hammoud MA, Jin FY, Degenhardt L, et al. Following lives undergoing change (Flux) study: Profile of an online cohort of drug use among gay and bisexual men in Australia. Int J Drug Pol. 2017;41:41–50.
Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13(1):117.
Haire BG. Preexposure prophylaxis-related stigma: strategies to improve uptake and adherence–a narrative review. HIV/AIDS (Auckl). 2015;7:241–9.
Girard G, Patten S, LeBlanc MA, Adam BD, Jackson E. Is HIV prevention creating new biosocialities among gay men? Treatment as prevention and pre-exposure prophylaxis in Canada. Soc Health Ill. 2018;41(3):484–501.
Holt M. Configuring the users of new HIV-prevention technologies: the case of HIV pre-exposure prophylaxis. Cult Health Sex. 2015;17(4):428–39.
Race K. Reluctant objects: sexual pleasure as a problem for HIV biomedical prevention. GLQ: J Lesbian Gay Stud. 2016;22(1):1–31.
Brooks RA, Landovitz RJ, Kaplan RL, Lieber E, Lee SJ, Barkley TW. Sexual risk behaviors and acceptability of HIV pre-exposure prophylaxis among HIV-negative gay and bisexual men in serodiscordant relationships: a mixed methods study. AIDS Patient Care STDs. 2012;26(2):87–94.
Hannaford A, Lipshie-Williams M, Starrels JL, et al. The use of online posts to identify barriers to and facilitators of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men: a comparison to a systematic review of the peer-reviewed literature. AIDS Behav. 2018;22(4):1080–95.
Holt M, Lea T, Bear B, et al. Trends in attitudes to and the use of HIV pre-exposure prophylaxis by australian gay and bisexual men, 2011–2017: implications for further implementation from a diffusion of innovations perspective. AIDS Behav. 2019;23(7):1939–50.
Holt M, Lea T, Schmidt HM, et al. Willingness to use and have sex with men taking HIV pre-exposure prophylaxis (PrEP): results of online surveys of Australian gay and bisexual men, 2011–15. Sex Trans Infect. 2017;93(6):438–44.
Hughes SD, Sheon N, Andrew EV, Cohen SE, Doblecki-Lewis S, Liu AY. Body/selves and beyond: men’s narratives of sexual behavior on PrEP. Med Anthropol. 2018;37(5):387–400.
Koester K, Amico RK, Gilmore H, et al. Risk, safety and sex among male PrEP users: time for a new understanding. Cult Health Sex. 2017;19(12):1301–13.
Newman PA, Guta A, Lacombe-Duncan A, Tepjan S. Clinical exigencies, psychosocial realities: negotiating HIV pre-exposure prophylaxis beyond the cascade among gay, bisexual and other men who have sex with men in Canada. J Int AIDS Soc. 2018;21(11):e25211.
Vaccher SJ, Gianacas C, Templeton DJ, et al. Baseline preferences for daily, event-driven, or periodic HIV pre-exposure prophylaxis among gay and bisexual men in the prelude demonstration project. Front Public Health. 2017;5:341.
Pound P, Britten N, Morgan M, et al. Resisting medicines: a synthesis of qualitative studies of medicine taking. Soc Sci Med. 2005;61(1):133–55.
Pilkington V, Hill A, Hughes S, Nwokolo N, Pozniak A. How safe is TDF/FTC as PrEP? A systematic review and meta-analysis of the risk of adverse events in 13 randomised trials of PrEP. J Virus Erad. 2018;4(4):215–24.
Dumit J. Drugs for life. Mol Interv. 2002;2(3):124–7.
Martin E. The pharmaceutical person. BioSoc. 2006;1(3):273–87.
Smyth JD, Dillman D, Christian LM, McBride M. Open-ended questions in web surveys: can increasing the size of answer boxes and providing extra verbal instructions improve response quality? Public Opin Q. 2009;73(2):325–37.
This study was funded by the Australian Research Council (ARC), ARC Grant number: DP140102483, and by a Gilead Research Fellowship. The institutes involved in this project receive funding from the Australian Government Department of Health. Two authors are funded by the award of a National Health and Medical Research Council Fellowship.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Philpot, S., Prestage, G., Holt, M. et al. Gay and Bisexual Men’s Perceptions of Pre-exposure Prophylaxis (PrEP) in a Context of High Accessibility: An Australian Qualitative Study. AIDS Behav 24, 2369–2380 (2020). https://doi.org/10.1007/s10461-020-02796-3