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Some gay and bi men see PrEP as a ‘social problem’

Some see PrEP as a “social problem” since its users were seen as promiscuous, irresponsible, immoral and naïve. They also believe that uptake of PrEP is undermining use of condoms and that PrEP users are responsible for ongoing epidemics of STIs among gay and bi men.

Everyone isn’t on the same page on PrEP.

Gay and bisexual men hold different attitudes towards men who use pre-exposure prophylaxis (PrEP), according to It’s just an excuse to slut around’: gay and bisexual mens’ construction of HIV pre-exposure prophylaxis (PrEP) as a social problem, a research done by M. Pawson, et al. and published in Sociology of Health & Illness.

The use of emtricitabine/tenofovir (Truvada) as PrEP was approved in the US in 2012; eventually also rolled out in other countries (including extremely limited and elitist distribution in the Philippines). Studies have shown that, with good adherence, PrEP can reduce the risk of HIV infection by almost 100%.

However, PrEP uptake has faced significant barriers, including knowledge, access and affordability.

Also, the integration of PrEP within existing HIV prevention efforts based on behavior change – especially consistent condom use – has encountered challenges, particularly when linked with the stigma associated with sexual promiscuity and “bareback” sex (unprotected anal intercourse with non-primary partners).

For this research, a series of focus group discussions were conducted in New York City. Thirty-two gay and bi men (with an average age of 35 years) were invited to share their views about PrEP, in late 2015 and early 2016. Most (n = 28) self-identified as gay and 11 were HIV positive.

Overall, the men had a good awareness of PrEP, with many reported seeing advertisements, discussion of PrEP on social media or said they had heard of PrEP from friends.

But not all the participants discussed PrEP accurately, with various misconceptions existing – e.g. that it’s a lifetime commitment, and that if one stopped taking PrEP and subsequently became infected with HIV the virus would be resistant to antiretrovirals because of previous exposure to medication.

Some of the men also see PrEP as a “social problem” since its users were seen as promiscuous, irresponsible, immoral and naïve. These same individuals believed that uptake of PrEP was undermining use of condoms and that PrEP users were responsible for ongoing epidemics of STIs among gay and bi men.

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The researchers noted that “by framing PrEP use as enabling gay and bisexual men to violate subcultural norms of sexual etiquette espoused in previous HIV prevention efforts, claims makers were able to present PrEP users as social problem villains,. Countering claims makers’ framing PrEP as a social problem, some men constructed PrEP as a helpful prevention tool in the fight against the HIV epidemic within gay and bisexual communities. Much of their discourse was couched within a harm reduction model in which PrEP medication is framed as significantly reducing the harm associated with engaging in risky sexual behavior.”

Those who participated also had notions of “deserving” and “undeserving” PrEP users – e.g. men in relationships with an HIV-positive partner fell into the “deserving” category.

“By studying the construction of PrEP as a social problem, we were able to highlight how gay and bi men define what they consider appropriate ways to prevent the spread of HIV. Public health organizations that design and disseminate HIV prevention messaging should strive to construct more inclusive definitions of sexual health practices in ways that seek to combat the stigma currently associated with those who make use of other preventions methods besides condoms,” the researchers ended.

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