Making the choice to start pre-exposure prophylaxis (PrEP) “extends beyond a simple assessment of perceived HIV risk,” researchers wrote in Psychology & Sexuality, and is instead “part of a complex consideration of many psychosocial influences such as HIV anxiety and resilience to social stigma.”
They continued that a better understanding of these psychosocial contexts “may help develop novel strategies to encourage PrEP usage.”
Anthony Gifford, PhD-candidate, and colleagues sought to enhance the current understanding of key psychosocial factors that positively and negatively impact PrEP usage among men who have sex with men (MSM). The researchers interviewed 22 MSM, most of whom were in their twenties or thirties. All had access to free PrEP.
The interviewer recorded participants’ demographics, current PrEP use, and attributes that defi ned their identities. Further questions explored:
› Attitudes toward and perceptions of PrEP;
› Navigation of perceived barriers to PrEP; and
› Perceived PrEP stigma.
The researchers observed that personal perceptions of HIV, community norms, and stigma greatly influenced participants’ attitudes toward PrEP.
Physician’s Weekly (PW) talked with Shahin Davoudpour, PhD, a researcher not involved in the study, about the issues it raises.
Why was it important to do this study?
The authors’ attention to the psychosocial influences on PrEP use is especially significant because it shifts the focus from policy and clinical perspectives to the potential user. This study emphasizes the need to pay closer attention to how individuals’ attitudes and identities, which are shaped by factors like social stigma and community dynamics, affect their decisions to use or reject PrEP.
Did the results surprise you?
The results were both surprising and unsurprising. On the one hand, similar attitudes, particularly regarding stigma, have been observed in other US-based research on PrEP, including my own. This suggests that stigma is a deeply rooted barrier to PrEP uptake, regardless of geographical location.
On the other hand, I was surprised because PrEP and attitudes toward it are often viewed as highly contextualized, shaped by the specific social, political, and healthcare contexts in which they emerge.
I agree with the authors’ assertion about the evolving perceptions of PrEP. While the HIV landscape has shifted dramatically over the decades, the stigma and anxiety surrounding HIV remain strikingly consistent. Ths suggests that, despite substantial progress, some psychological and social barriers continue to have a significant impact on individuals’ engagement with HIV prevention recommendations like condom use, regular testing, and PrEP.
How do differences in the US affect PrEP use by MSM?
In the US, differences in healthcare access, political climate, and cultural attitudes significantly impact how PrEP is perceived and used among sexual minorities. Healthcare disparities, particularly for marginalized groups, create barriers to access, making PrEP less available for those who might benefit most from it. Politically, issues such as healthcare policy and funding debates along with stigma shape the public’s perception of PrEP as a prevention tool.
Socially and culturally, the perception of sexual health behaviors, such as condom use versus PrEP, can lead to misunderstandings about safe sex, with PrEP often seen as the solution rather than part of a holistic approach to sexual health. Additionally, there’s a notable stigma around PrEP use in the US, with users frequently labeled as promiscuous or presumed to be HIV-positive, which complicates its widespread acceptance.
Could a better understanding lead to novel strategies to encourage PrEP use?
Understanding the psychosocial contexts around PrEP can lead to more targeted, effective strategies for encouraging PrEP usage in the US by addressing the deeper, often unspoken factors that shape individuals’ decisions around HIV prevention.
As the authors highlight, attitudes toward PrEP are deeply influenced by personal perceptions of HIV, societal stigma, and community norms. In the US, where PrEP uptake remains suboptimal despite systemic eff orts, addressing the psychological barriers such as HIV anxiety, stigma, and moral conflicts could be as critical as expanding access to the medication itself. By focusing on these psychosocial aspects, strategies can be developed to reduce PrEP stigma. This could involve creating supportive environments where individuals feel empowered to make informed decisions about their sexual health, free from societal judgment.
More personalized outreach, community-based support systems, and interventions that address specific psychosocial barriers could ultimately increase PrEP uptake. This is particularly true among those who may be hesitant or ambivalent due to the social and psychological consequences of PrEP use.
