Perspectives on Social Support and Stigma in PrEP-related Care Among Gay and Bisexual Men on PrEP: A Qualitative Investigation

Men who have sex with men (MSM) are disproportionately impacted by HIV. Today, one of the most effective and innovative HIV prevention tools available is pre-exposure prophylaxis (PrEP). Despite its remarkable effectiveness at preventing HIV transmission, awareness and uptake of PrEP as a prevention strategy has been slow to take hold. As evidenced in previous literature, experiences of stigma have been found to negatively impact psychological and physical stress, and medication adherence. Social support has been found to buffer against some of these psychological and behavioral responses. This study explored the psychosocial dimensions of PrEP use among MSM to promote PrEP awareness and retention. Semistructured interviews were conducted with MSM who use PrEP (N = 20) to explore how social support is related to their PrEP-related care and their perceptions and experience of stigma related to PrEP use. Data were analyzed using Strauss and Corbin\u27s grounded theory to enhance understanding of the lived experiences of MSM who currently use PrEP. Social support was found an important layer in PrEP-related care that promoted adaptive behavioral responses, such as adherence to care, enhancing resilience to stress, and increased sexual identity. In addition to providing protection against HIV, participants also described the psychosocial benefits of PrEP in terms of reducing HIV-related anxiety and fears. Lastly, this study also demonstrated that relationship status and PrEP-related stigma may also be a barrier to care or a source of additional stress for many MSM on PrEP. Findings suggest that PrEP has significant impacts beyond biomedical outcomes for both the individuals who use PrEP and their communities. They connected PrEP stigma and generational differences that have important implications for PrEP acceptability and the wellbeing of MSM from all age cohorts. Rather than talking about being overly burdened by stigma or shame, many participants discussed being understood and proud because of their PrEP use. The narratives this study has illustrated may help demonstrate that social support may help buffer against the stigma surrounding PrEP. These findings point to a need to develop tailored interventions to address psychosocial dimensions of PrEP for individuals and health-care professionals