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The Impact of PrEP on the Sex Lives of MSM at High Risk for HIV Infection: Results of a Belgian Cohort


There is a need for an in-depth understanding of the impact of PrEP on users’ sexual health and behaviour, beyond the focus on ‘risk’. This mixed-method study was part of a Belgian PrEP demonstration project following 200 men who have sex with men (MSM) for at least 18 months. Taking a grounded-theory approach, 22 participants were interviewed and their transcripts analysed. The preliminary analysis guided the analysis of the questionnaire data. Overall, PrEP improved sexual health. Participants felt better protected against HIV, which enabled them to change their sexual behaviour. The reduction in condom use was moderated by interviewees’ attitudes towards the risk for other STIs. Other changes included having more anal sex and experimentation with new sexual behaviours. While PrEP empowers MSM in taking care of their sexual health, comprehensive sexual health counselling is crucial to provide care for users who feel less in control over their sexual health.

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Data Availability

Data not available due to ethical restrictions.


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The study was funded by the Flemish Agency for Innovation and Entrepreneurship, as Applied Biomedical Research. The study medication was donated by Gilead Sciences. TR is a postdoctoral fellow of the Research Foundation Flanders. We further thank the Be‐PrEP‐ared study group, the laboratory staff, the Community Advisory Board and all the study participants.


A Grant was obtained from the Flemish Agency for Innovation and Entrepreneurship. TR is a postdoctoral fellow of the Research Foundation Flanders. Gilead Sciences donated the drugs (Truvada) for the study.

Author information




All authors contributed to study conception and design, data collection and data analysis. The first draft of the manuscript was written by TR and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Thijs Reyniers.

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The authors declare that there is no conflict of interest.

Ethics Approval

The Be-PrEP-ared study received ethical approval of the institutional review board of the Institute of Tropical Medicine (Antwerp) and the Ethical Committee of the Antwerp University Hospital.

Informed Consent

All participants provided informed consent.

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Reyniers, T., Nöstlinger, C., Vuylsteke, B. et al. The Impact of PrEP on the Sex Lives of MSM at High Risk for HIV Infection: Results of a Belgian Cohort. AIDS Behav 25, 532–541 (2021).

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  • MSM
  • Pre-exposure prophylaxis
  • HIV prevention
  • Sexual behaviour