Exchanging a “Gnawing Thought for “Taking a Pill Once a Day”: Examining Sexual Minority Men's Experiences With PrEP and Mental Health in a Universal PrEP Access Context

Abstract

This study explores how universal access to and taking no-cost preexposure prophylaxis (PrEP), which effectively prevents HIV acquisition, may impact the mental health-related experiences of sexual minority men, including HIV-related anxiety. We employed community-based and participatory methods to conduct and analyze 27 interviews with sexual minority men in British Columbia, Canada. Before starting PrEP, participants’ experiences with sex were highly associated with HIV-related anxiety. Participants stated they did not explicitly initiate PrEP to reduce HIV-related anxiety, yet many described significant reductions of HIV-related anxiety after starting PrEP. Participants described feeling that the sex they were having was safer following their initiation of PrEP, which resulted in increased ability to access heightened experiences of pleasure, desire, and intimacy. PrEP's capacity to impact HIV stigma and health broadly should continue to be explored, particularly given the mental health inequities faced by those who may acquire HIV.