The experiences of low-risk and HIV anxious gay men who are using HIV pre-exposure prophylaxis (PrEP): A qualitative study

Aims: To explore the experiences of low-risk, HIV anxious gay and bisexual men (GBM) who use HIV Pre-Exposure Prophylaxis (PrEP) and the impact PrEP use has on their sexual behaviour and experience of anxiety. Background: PrEP has demonstrated significant protection against HIV infection among GBM who are high-risk and is becoming increasingly popular. Anecdotal reports suggest that low-risk, HIV anxious GBM are using PrEP. HIV anxiety in GBM is a poorly understood phenomenon that is usually conceptualised within cognitive-behavioural models. This may neglect the impact of minority status and the specific psychosocial processes associated with this, such an internalised homophobia. PrEP use is associated with less worry and improved sexual functioning and it is unknown whether these benefits will be realised among PrEP-using, low-risk GBM who are HIV anxious. Methodology: Qualitative methodology was employed within an interpretivist paradigm. 10 gay men were recruited from sexual health clinics in central London. Participants were included in the current study through either historically or currently meeting diagnostic criteria for Illness Anxiety Disorder, were considered low risk for acquiring HIV infection and had been using PrEP for at least 3 months. In-depth semi-structed interviews were conducted. Data was analysed by means of thematic analysis. Results: Twenty-two themes, and accompanying subthemes, were extracted from participants’ data. Participants experienced adversity in adjusting to their sexuality. These experiences may have led to internalised homophobia that impacted perception of sexuality and contributed to development of HIV anxiety. HIV anxiety was characterised by various cognitive and behaviour manifestations, as well as shame. PrEP use was initiated to mitigate anxiety symptoms and improve psychological and psychosexual functioning. All participants experienced less anxiety and improved psychosexual functioning after starting PrEP. Conclusions: HIV anxiety in GBM may be a consequence of psychosocial processes associated with minority stress. The experience of HIV anxiety in GBM is not adequately captured within current diagnostic classifications or psychological theories and models of anxiety disorders. PrEP use in this group may be better conceptualised as a community adaptive coping strategy rather than a safety behaviour. PrEP therefore may be a useful intervention for GBM who are HIV-anxious.