Interesting qualitative study regarding prep and stigma surrounding it and why it becomes a hindrance for people to use it.
Two new qualitative studies from Toronto shed light on how stigma affects the uptake of pre-exposure prophylaxis (PrEP) and the experience of taking it. In the first, young gay men acknowledged that they did not always use condoms but did not see themselves as the kind of ‘barebacker’ for whom they thought PrEP was intended.
“PrEP embodies the notion of bareback sex, which traditionally has been associated with negative elements, and it is quite clear that the young gay men in this research do not want to be associated as a barebacking subject,” writes Julien Brisson in Anthropology & Medicine. “This is one reason why they did not want to use PrEP.”
In the second study, early adopters described concealing their PrEP use because of what it might suggest to others about their sexual behaviour. Nonetheless, most had an overwhelmingly positive experience of taking PrEP.
“Paradoxically, some men said that PrEP use both led them to experience stigmatizing reactions within their social and sexual networks, while also helping to remove stigma, shame, and fear related to HIV, sexuality, and sex with gay men living with HIV,” comments Daniel Grace in AIDS Patient Care and STDs.
Young gay men’s feelings about barebacking and PrEP
Julien Brisson of the University of Montreal conducted ethnographic fieldwork with young gay men in a gay neighbourhood of Toronto. As well as in-depth interviews with ten men, he reports on informal interactions at gyms, social events, an LGBT film festival and meetings about HIV prevention. Most of his informants were in their twenties and well-educated, although his interview sample was ethnically diverse.
The research was conducted in 2014, before PrEP was approved by Canadian regulators in February 2016. This was also before PrEP was added to Ontario’s provincial drug programme in September 2017, a move that has facilitated access to PrEP in Toronto, especially for people on low incomes.
The men taking part in the research were generally well-informed about HIV prevention. Having had their first sexual relations in the 2000s, they were highly aware of HIV prevention messages about condoms. They were also knowledgeable about the biomedical science relating to HIV prevention, often using pragmatic techniques such as ‘serosorting’ and ‘strategic positioning’ to diminish the risk of HIV transmission when they did not use condoms.
Of note, on the first occasions that the researcher met his respondents, they all reported that they did not have bareback sex. They tended to express the idea that it was a bad and reckless practice. In line with the way in which medical and psychological researchers have represented men who bareback, the young gay men often described barebackers as people who had problems with depression, self-esteem or drug use.
For example, Brisson describes meeting a 25 year old at a party and explaining that his research was on bareback sex. The young man said with a tone of pride that he was a responsible person who always used condoms, while other men attending the party nodded in approval or said that they did the same.