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What people want from sex and preexposure prophylaxis

Grant, Robert M.a,b,c; Koester, Kimberly A.b

Current Opinion in HIV and AIDS: January 2016 - Volume 11 - Issue 1 - p 3–9
doi: 10.1097/COH.0000000000000216
THE PREP REVOLUTION: FROM CLINICAL TRIALS TO ROUTINE PRACTICE: Edited by Jared Baeten Sheena McCormack
Editor's Choice

Purpose of review As demand for preexposure prophylaxis (PrEP) increases, we are learning more about what people want from sex and PrEP.

Recent findings PrEP demand has reached a tipping point in the USA and is increasing rapidly. Although the primary benefit of PrEP use is biological, to reduce risk of HIV infection, PrEP users often express an alternative set of social and emotional benefits that are provided by PrEP. These collateral benefits of PrEP have salience, affect, and are experienced in the present, which are compelling drivers of human behavior. PrEP use has been associated with feeling safe during sex, usually in contrast to ruminations related to fear of HIV or intimate partner violence or control. PrEP can create empowerment, or agency, defined as the capacity and autonomy to act on one's own behalf, because it provides control over one's vulnerability to HIV and relief to women and men who may otherwise worry about whether their partners will use a condom, take antiretroviral therapy, or disclose their HIV status accurately. Planning for sexual and social goals in calm moments is also empowering. These highly desired collateral benefits of PrEP could be undermined, or eliminated, if PrEP is implemented in ways that are coercive or that foment fear of sexual risk compensation, drug resistance, toxicity, or moral judgment.

Summary Current PrEP implementation provides direct and indirect benefits that are highly desired.

aGladstone Institutes

bUniversity of California

cSan Francisco AIDS Foundation, San Francisco, California, USA

Correspondence to Robert M. Grant, MD, MPH, Gladstone Institutes, 1650 Owens Street, San Francisco, CA 94158, USA. Tel: +1 415 350 8909; e-mail: Robert.grant@ucsf.edu

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