“I Feel That I’m Finally Fully Enjoying Sex For The First Time In My Life”: The Impact Of Prep On Sexual Cultures From The SIN-Prep Study

“I FEEL THAT I’M FINALLY FULLY ENJOYING SEX FOR THE FIRST TIME IN MY LIFE”:THE IMPACT OF PREP ON SEXUAL CULTURES FROM THE SIN-PREP STUDYHaire B1,2 ,Maher L1, Vaccher S1, Callander D1, Cook T3, Murphy D4, Kaldor J1,Zablotska-Manos I11The Kirby Institute 2Australian Federation of AIDS Organisations 3 ACON4University of SydneyBackground: More than 6,100 gay and bisexual cisgender and transgender men(GBM) are accessing HIV pre-exposure prophylaxis (PrEP) in NSW through theEPIC-NSW study. Sin-PrEP explores the culture of PrEP adoption and changingmeanings of ‘safe sex’.Methods: Between 2015 and 2017 in-depth interviews were conducted with 25 PrEPusers, 7 sexually active PrEP non-users and 7 healthcare providers. Six participantswere re-interviewed 9-18 months after their first interview. Three focus groups wereconducted with professionals in Sydney and Melbourne. Data were analysedthematically.Results: Themes included risk-reduction, access, anxiety, sexual capital, stigma,sexual citizenship, reciprocity, responsibility, risk, negotiation, and changingpractices over time. Of the 25 PrEP users, four had switched from personalimportation to the EPIC-NSW trial, and three had ceased use. Participants reporteda range of risk reduction practices. Most users reported reducing their condom usefollowing PrEP uptake. Almost all men had accessed PEP prior to PrEP, includingtwo using PEP-as-PrEP. Healthcare providers and HIV negative non-PrEP usersexpressed concerns about potential increases in STIs. Positive social implications ofPrEP included relief from HIV anxiety, easier sexual negotiation betweenserodiscordant partners, and a burgeoning of informal peer-based sexual healthsupport in response to increasing complexity of HIV prevention options.Apprehension that PrEP was becoming a new norm that reduced the sexual capitalof non-users was a negative implication.Conclusion: Sex cultures in GBM are changing. Some aspects of PrEP adoptionreported in SIN-PrEP indicate a developing culture of care and mutual responsibility.There is however also evidence of normative pressure to adopt PrEP over condomuse to maintain sexual capital. Potential increases in STIs are also of concern tosome community members. Health promotion specialists need to engage with boththe negative and positive impacts of PrEP to support an inclusive culture thatminimises HIV risk.Disclosure of Interest Statement: Bridget Haire receives funding support from theNHMRC. This study has received in-kind support from ACO