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PrEP May Offer Psychological Benefits to Gay, Bisexual Men at Risk for HIV


A new study has identified lower rates of sexual anxiety among gay and bisexual men taking pre-exposure prophylaxis (PrEP).

Pre-exposure prophylaxis (PrEP) might offer psychological benefits to gay and bisexual men who have heightened fear of HIV infection, according to a new study, which identified lower rates of sexual anxiety among these men taking the pill.

Among the more than 1000 gay and bisexual men included in the study, 137 began taking PrEP within the 24 months following baseline. While potential confounders, such as relationship status and having a college degree, did not yield significant differences in sexual anxiety, the initiation of PrEP demonstrated a significant decrease, with a drop of 0.27 points compared with the time prior to PrEP initiation.

Research surrounding PrEP has traditionally focused on acceptability of and adherence to the pill, resulting in a lack of knowledge when it comes to the psychological impact on users.

“The fear of HIV acquisition among gay and bisexual men has been well researched and is often linked to negative affect,” wrote the researchers. They hypothesized that “with the effectiveness of PrEP in preventing HIV infection, it is possible that such fears may decrease among PrEP users.”

The One Thousand Strong study followed 1071 gay and bisexual men in the United States who reported on their PrEP use at baseline, 12 months, and 24 months. Participants also completed the Multidimensional Sexual Self-Concept Questionnaire (MSSQC) to determine measures of their sexual satisfaction, sexual esteem, and sexual anxiety, with higher scores indicating a higher prevalence of each factor.

Among the 137 participants who initiated PrEP during the study period, the researchers collected data on 393 time points. Looking at sexual satisfaction and sexual esteem, the researchers did not observe significant difference following uptake of PrEP.

The researchers noted that anxiety can linger for months after engaging in condomless anal sex, with some gay and bisexual men avoiding HIV testing because of fear of the results, which may influence their decision to take PrEP.

“Gay and bisexual men who use PrEP do not necessarily do so for the same reasons, and there may be additional variables that could be examined in understanding the decrease in anxiety,” they added. “For example, we included the number of condomless anal sex partners; however, we did not measure participants’ perceptions of their sexual risk prior to and after beginning a PrEP regimen.”

According to the researchers, future research should include an examination of psychological benefits to use of PrEP and how they can be leveraged in order to increase uptake of PrEP for people at risk of HIV. They also suggest that more work needs to be done to determine exactly what aspects of sexual anxiety may be impacted by PrEP and if there are other affective changes.


Whitfield T, Jones S, Wachman M, Grov C, Parsons J, Rendina H. The impact of pre-exposure prophylaxis (PrEP) use on sexual anxiety, satisfaction, and esteem among gay and bisexual men [published on line February 19, 2019]. J Sex Res. doi: 10.1080/00224499.2019.1572064

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