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Kolstee J, Prestage G, Philpot S, Bavinton B, Hammoud M, Keen P, Holt M. The effect of pre-exposure prophylaxis (PrEP) on negotiating casual sex between gay men: disclosure, assumptions, and communication. Sex Health 2023; 20:64-70. [PMID: 36508715 DOI: 10.1071/sh22095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The disclosure of HIV status and pre-exposure prophylaxis (PrEP) use can be important in the negotiation of safe sex. With the rapid uptake of PrEP in Australia, norms and expectations about discussion and disclosure may have changed. METHODS We explored the disclosure of PrEP use, HIV status and communication with sex partners by HIV-negative gay men in Sydney, Australia. We conducted semi-structured interviews from October 2017 to May 2018 and analysed data using a codebook thematic analysis approach. RESULTS Participants had a variety of expectations of what they should tell their partners and what they expected in return. For some participants, PrEP had negated the need for any discussion about HIV. Many participants assumed their partners would find information about their HIV status or PrEP use on their online profiles or that partners would ask, if necessary. CONCLUSIONS Building a stronger, shared understanding among gay men that disclosure and discussion no longer automatically occur before sexual encounters may be useful.
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Affiliation(s)
- Johann Kolstee
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Garrett Prestage
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Steven Philpot
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Benjamin Bavinton
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Mohamed Hammoud
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Phillip Keen
- Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Kensington, NSW, Australia
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Sudarto B, Chow EPF, Medland N, Fairley CK, Wright EJ, Armishaw J, Price B, Phillips TR, Ong JJ. "How PrEPared are you?": Knowledge of and attitudes toward PrEP among overseas-born and newly arrived gay, bisexual, and other men who have sex with men in Australia. Front Public Health 2022; 10:946771. [PMID: 36062118 PMCID: PMC9437584 DOI: 10.3389/fpubh.2022.946771] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/22/2022] [Indexed: 01/21/2023] Open
Abstract
Introduction Overseas-born and newly arrived gay and bisexual men and men who have sex with men (GBMSM) are at higher risk of acquiring HIV in comparison to Australian-born GBMSM. Pre-exposure prophylaxis (PrEP) is subsidized by the Australian government under Medicare, Australia's universal health insurance scheme, however many members of this population are Medicare-ineligible, which could prevent them from accessing PrEP. We wanted to explore participants' knowledge of and attitudes toward PrEP and their opinions of new PrEP modalities, namely injectable PrEP and PrEP implants. Methods We conducted in-depth qualitative interviews between February 2021 to September 2021 with 22 overseas-born, newly arrived (<5 years in Australia) GBMSM of varying PrEP use. We asked their opinions of PrEP and their preferences of new PrEP modalities. Interviews were audio recorded and transcribed verbatim. We conducted a reflexive thematic analysis to interpret the data. Results Participants' views reflect the intersections between systemic factors, such as Medicare ineligibility and the high cost of PrEP, with socio-cultural factors, such as lack of knowledge about PrEP, internalized stigma stemming from homo- and sex-negativity, and stigmatizing attitudes toward PrEP and PrEP users. For participants who were on PrEP, being community connected, having a positive relationship with doctors and nurses, and being informed of the option to purchase PrEP from overseas pharmacies at a low cost helped them to overcome some of these barriers. Additionally, there was a strong preference for injectable PrEP but not PrEP implants. Participants stressed the importance of providing a comprehensive information about PrEP specific to this population and to make PrEP free for all. Conclusions We concluded that resources about PrEP specific to this population that address both systemic and socio-cultural factors are needed, and for these resources to be available in languages other than English. This is to coincide with on-going advocacy to increase the capacity of publicly funded sexual health clinics to provide multilingual PrEP services for people without Medicare, and to make PrEP free for all. These combined strategies have the potential to increase PrEP knowledge and uptake among this population.
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Affiliation(s)
- Budiadi Sudarto
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia,*Correspondence: Budiadi Sudarto
| | - Eric P. F. Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nicholas Medland
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia,The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Christopher K. Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Edwina J. Wright
- The Burnet Institute, Melbourne, VIC, Australia,The Peter Doherty Institute for Infection and Immunity, University of Melbourne and the Royal Melbourne Hospital, Melbourne, VIC, Australia,Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Jude Armishaw
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Brian Price
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Tiffany R. Phillips
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Jason J. Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
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