Pills, pleasure and privacy: Early experiences of Pre-exposure Prophylaxis among men in the VicPrEP study

Background:To date, research on PrEP has focused on efficacy, adherence, and potential impact on existing HIV prevention strategies. Little attention has been paid to what PrEP means to those who take it.Methods:Participants in the VicPrEP study were invited to participate in a face-to-face in-depth interview about their experiences of PrEP. A total of 18 interviews with men were conducted and analysis followed a deductive approach. Coding of data was informed by the existing literature on PrEP and a reflective approach to the generative nature of biomedicine and research. Results:The accounts of participants suggested the emergence of a new HIV-negative identity — one that was more definite (less ambiguous) than a HIV-negative status in the absence of PrEP. This identity emerged through interactions with sexual partners. Through these interactions, disclosure of being ‘on PrEP’ called into question the assumed HIV-negative status of potential sexual partners.This new negative status had two implications: first, was a changed relationship to HIV testing, which was no longer associated with anxiety about a possible positive result, but became a test that monitored the performance of Truvada (PrEP). Second, was a changed relationship to disclosure. Knowledge a sexual partner’s serostatus became less important than prior to PrEP. Moreover, disclosing one’s own negative status was also less important because a PrEP-enhanced status was expressed as meaning he posed no HIV risk to others.Conclusion:Men’s understanding of themselves as PrEP users differed from previous conceptions of the experience of what it is to negotiate HIV-negative status. More specifically, experiences of disclosure, sex, and testing as reported within the constraints of the study suggested that the experience of HIV may be different in a post-PrEP environment. Hence PrEP may be considered a new contributor to a dynamic epidemic, opening possibilities for new engagements with prevention