PrEP and Sexual Well-Being: A Qualitative Study of the Impact of PrEP on Sexuality of MSM and the Effects of Sexual Health Care from PrEP Providers on PrEP Persistence Open Access

Devarajan, Sinthuja (Spring 2019)

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Background: Minimal uptake of Truvada for HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) has prompted studies about patient-provider dynamics, prescription practices, and patient perceptions of healthcare. Previous literature has shown that barriers to uptake and prescription are related to perceptions of sexual behaviors among MSM. In the gay community, people who use PrEP are perceived to be promiscuous while healthcare providers often cite concerns about behavioral risk compensation among MSM who use PrEP. These concerns related to sexual behaviors have been noted as barriers to PrEP uptake, but there is a paucity of research investigating the impact of elements of sexuality on the persistent use of PrEP.

Objectives: The purpose of this qualitative study is to examine the impact of PrEP use on elements of sexuality among MSM, explore how MSM patients experience sexual health care with PrEP providers, and to understand how sexual health care impacts PrEP persistence among MSM in the context of evolving sexuality.

Methods: The primary researcher conducted semi-structured interviews with 20 MSM adults in Atlanta, Georgia with current or past prescriptions for PrEP. A thematic analysis approach was used for data analysis and consisted of four major steps: 1) code and codebook development, 2) assigning codes to segments of interviews, 3) code-based and comparative analysis methods, and 4) developing thematic findings. Constructs from the information-motivation-behavioral skills (IMB) theory informed the development of interview guides and deductive codes used in analysis.

Results: Findings from interviews with MSM confirm and extend previous literature pertaining to changes in sexuality while using PrEP such as decreased feelings of anxiety surrounding sex, feelings of control over personal health without dependence on sexual partners, and less stigma regarding sex with MSM who have HIV. Participants indicated PrEP healthcare needs such as tailored sexual health advice based on individual sexual preferences, provision of non-judgemental sexual health care, and improved access to PrEP providers who identify as gay men or who practice in LGBT-friendly settings. Data linkages regarding PrEP persistence were thin, though some data indicated that PrEP provider judgment and perceived lack of investment in the patient may translate to patient disregard for personal sexual health.

Conclusions: The findings from this study support a need for a gain-frame approach to sexual health especially among MSM. Study results regarding MSM PrEP patient perceptions of their sexual health care may inform LGBT medical education, contribute to medical guidelines for constructing effective patient-centered sexual health recommendations, and support future research about MSM medical care and PrEP persistence.

Table of Contents

Chapter One: Introduction                                                            1

Chapter Two: Review of Literature                                              6

Chapter Three: Student Contribution                                        13

Chapter Four: Journal Article                                                       15

Chapter Five: Public Health Implications                                  38

References                                                                                   47

Appendix A: In-Depth Interview Guide                                     54     

Appendix B: Oral Consent Form                                                  56

Appendix C: MSM Participant Demographic Survey               58

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