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Acceptability of PrEP for London gay men affected by perception of risk, sexual partners’ attitudes and the stigmatisation of sex
Roger Pebody, 2016-09-09 07:10:00
PrEP is broadly acceptable to London gay men who are at risk
of acquiring HIV, with many men seeing its potential to protect them from
infection and to reduce anxiety during sex. Nonetheless the lack of honest
discussion about sex and risk with friends, peers and in the wider community is
likely to impact the acceptability of PrEP, according to a doctoral thesis by Will Nutland at the
London School of Hygiene and Tropical Medicine.
“Those seeking to undertake future research or practice into
PrEP acceptability should understand that ‘acceptability’ means far more than
whether a technology will work, whether people will be willing to use it, or
whether it will cause side effects,” he says. “Acceptability models need to
capture social dimensions, and understand that that personal considerations are
shaped – and in themselves shape and influence – inter-personal and community
or societal dimensions.”
His data come from in-depth, qualitative interviews
conducted with 20 gay men living in London. Participants were given information
about potential PrEP methods and the results of the iPrEx and CAPRISA studies,
and given the space to reflect on the possibilities that the new methods
Of note, the interviews were conducted in late 2012, when
awareness of PrEP was relatively limited in London. Participants were being
asked hypothetical questions about potential products that they may not have
heard of before the interview.
All interviewees were HIV-negative; the majority were white
and university-educated; ages ranged from 21 to 45. One of the criteria for
participation in the study was to have had sex without a condom with a man not
known to be HIV-negative – they were therefore men who might benefit from new
HIV prevention methods.
Most participants recognised that their risk reduction
strategies (e.g. regular testing, trying to avoid sex without condoms with HIV-positive
partners) were not infallible. They offered a variety of explanations for occasions
when they had had sex without a condom, including loss of control (e.g. being
pressured by a partner; drink and drugs) and ‘psychological’ explanations (e.g.
depression; low self-esteem; a desire for transgressive sex).
Many simply felt that condomless sex had ‘just happened’ –
it took place in the ‘heat of the moment’ for reasons that the men could not
easily describe but mostly seemed to relate to a dominance of sexual desire
over cognitive risk appraisal.
Roughly a third of the interviewees said they would
definitely want to take PrEP if it was available, a third would consider it,
and a third would not want to take it.