The first study to explore United Kingdom men's perceptions of PrEP – a new HIV prevention treatment – has found that their opinions are negatively influenced by social stigma. The article published in Cogent Medicine provides alarming new evidence that the fight against AIDS in the UK is still being undermined by common misconceptions and social stigma. The article calls on the medical profession and media to do more to improve perceptions and understandings of the potentially life-saving drug.
Men who have sex with men (MSM) are the group most affected by HIV in the UK. Around 45,000 MSM were living with HIV in the UK in 2014, with approximately 1 in 11 MSM being HIV-positive in London alone. The health issue posed by HIV is enormous and has shown no signs of decreasing over the last decade.
Pre-exposure prophylaxis (PrEP) is a novel HIV prevention option for individuals at high risk of HIV exposure. The drug Truvada has been available as PrEP in the USA since 2012 and is currently in clinical trials in the UK. It has been shown to be a highly effective form of preventing HIV infection, but PrEP remains controversial. Whilst the treatment could become available in the UK soon, what do its potential users actually think of it?
To find out, the authors of the study conducted in-depth qualitative interviews with a small focus group of MSMs, comprising of both HIV-positive and HIV-negative individuals. The interviewees were asked about their views on PrEP in terms of their knowledge of the treatment and their feelings towards it.
The results of the interviews firstly revealed that PrEP was perceived as an uncertain method of protecting against HIV infection, the fear stemming from a general mistrust of scientists and public health experts who "can make mistakes too." Individuals also did not seriously believe that they would use condoms consistently while taking PrEP, which is essential to the treatment's effectiveness.
Participants also attached large amounts of social stigma to the idea of being at "high-risk" of infection, with many rejecting the treatment simply on the grounds that they do not wish to view themselves in that stigmatised category. One HIV-negative participant said he thought PrEP would not benefit him because he did not perceive himself as "high-risk", despite reporting multiple condomless sexual encounters, because he was not "Someone who is out at chemsex parties every weekend." This demonstrates a general lack of understanding about what constitutes high-risk actions.
Other participants made reference to the US stigma of not wanting to be seen as a "Truvada Whore", namely someone who engages in frequent reckless sexual behaviour because they believe they are made safer by taking PrEP. The authors of the study believe this kind of stigma is a reproduction of negative representations of PrEP that have been propagated in press reporting, leading ultimately to 'individuals perceiving the treatment as a potentially viable HIV prevention tool at a population level, but unsuitable for themselves personally.'
The authors further comment that perceptions of PrEP will only change if healthcare professionals and the media alter their approach to how they represent the treatment. It will be 'more effective to present PrEP as a "further level of protection" against HIV, in addition to condoms and other prevention strategies. The societal perception that PrEP and condoms are mutually exclusive engender further stigma and division at a time where acceptance and unity are key.'
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Rusi Jaspal et al. Perceptions of pre-exposure prophylaxis (PrEP) among HIV-negative and HIV-positive men who have sex with men (MSM), Cogent Medicine (2016). DOI: 10.1080/2331205X.2016.1256850