Sexual satisfaction with daily oral HIV pre-exposure prophylaxis (PrEP) among gay and bisexual men at two urban PrEP clinics in the United States: an observational study
Madeline C. Montgomery
A E , Jacqueline Ellison B , Philip A. Chan A C , Laura Harrison C and Jacob J. van den Berg A C D
+ Author Affiliations
- Author Affiliations
A Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
B Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
C Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
D Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
E Corresponding author. Email: madeline_montgomery@brown.edu
Sexual Health 18(4) 319-326 https://doi.org/10.1071/SH20207
Submitted: 13 November 2020 Accepted: 14 May 2021 Published: 27 August 2021
Abstract
Background: Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV infection among men who have sex with men (MSM). However, limited data are available on the effect of PrEP use and sexual satisfaction among MSM taking PrEP. Methods: We conducted a one-time, cross-sectional survey of MSM receiving PrEP care at two hospital-based PrEP clinics in Providence, Rhode Island and Boston, Massachusetts, USA (April–September 2017). We oversampled Black and Hispanic/Latino individuals. Participants completed the 20-item New Sexual Satisfaction Scale (NSSS) twice, once for before and once for after starting PrEP. Participants reported sexual behaviours, PrEP adherence, PrEP attitudes, and quality of life with PrEP. Results: A total of 108 gay and bisexual men (GBM) participated. Overall, 15.7% were Black (non-Hispanic/Latino) and 23.1% were Hispanic/Latino, with an average age of 36.6 years. Most participants reported private health insurance coverage (71.3%), and 88.9% identified as homosexual, gay, or same gender-loving. The mean NSSS score before PrEP initiation across all 20 items was 3.94 (maximum = 5; 95% CI: 4.22, 4.43), and increased significantly after PrEP initiation (4.33, 95% CI: 4.22, 4.43; P < 0.001). Most participants (73.2%) reported that PrEP increased quality of life. This was associated with significant change in pre- to post-PrEP NSSS scores (linear regression coefficient = 1.21; 95% CI: 0.585, 1.84). Conclusions: Initiating PrEP and reporting improved quality of life were significantly associated with an increase in sexual satisfaction. PrEP implementation efforts should consider sexual satisfaction to promote PrEP engagement and retention, and researchers and providers should adopt a sex-positive approach with PrEP patients, especially among MSM.
Keywords: HIV prevention, men who have sex with men, PrEP, public health, sexual experience, sexuality, sexual satisfaction, quality of life, sexual health care.
References
[1] Centers for Disease Control and Prevention. HIV surveillance report: Diagnoses of HIV infection in the United States and dependent areas, 2018 (updated). 2020. Available at https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2018-updated-vol-31.pdf[2] Hess KL, Hu X, Lansky A, Mermin J, Hall HI. Lifetime risk of a diagnosis of HIV infection in the United States. Ann Epidemiol 2017; 27 238–43.
| Lifetime risk of a diagnosis of HIV infection in the United States.Crossref | GoogleScholarGoogle Scholar | 28325538PubMed |
[3] Race K. Reluctant objects: sexual pleasure as a problem for HIV biomedical prevention. GLQ 2016; 22 1–31.
| Reluctant objects: sexual pleasure as a problem for HIV biomedical prevention.Crossref | GoogleScholarGoogle Scholar |
[4] Higgins JA, Hirsch JS. The pleasure deficit: revisiting the “sexuality connection” in reproductive health. Perspect Sex Reprod Health 2007; 39 240–7.
| The pleasure deficit: revisiting the “sexuality connection” in reproductive health.Crossref | GoogleScholarGoogle Scholar | 18093041PubMed |
[5] Powell VE, Gibas KM, DuBow J, Krakower DS. Update on HIV preexposure prophylaxis: effectiveness, drug resistance, and risk compensation. Curr Infect Dis Rep 2019; 21 28
| Update on HIV preexposure prophylaxis: effectiveness, drug resistance, and risk compensation.Crossref | GoogleScholarGoogle Scholar | 31227999PubMed |
[6] Nunn AS, Brinkley-Rubinstein L, Oldenburg CE, Mayer K, Mimiaga MJ, Chan PA. Defining the pre-exposure prophylaxis care continuum. AIDS 2017; 31 731–4.
| Defining the pre-exposure prophylaxis care continuum.Crossref | GoogleScholarGoogle Scholar | 28060019PubMed |
[7] US Food and Drug Administration (FDA). FDA approves first drug for reducing the risk of sexually acquired HIV infection. 2012. Available at https://www.hiv.gov/blog/fda-approves-first-drug-for-reducing-the-risk-of-sexually-acquired-hiv-infection
[8] US Food and Drug Administration (FDA). FDA approves second drug to prevent HIV infection as part of ongoing efforts to end the HIV epidemic. 2019. Available at https://www.fda.gov/news-events/press-announcements/fda-approves-second-drug-prevent-hiv-infection-part-ongoing-efforts-end-hiv-epidemic
[9] Chan PA, Patel RR, Mena L, Marshall BD, Rose J, Sutten Coats C, et al Long-term retention in pre-exposure prophylaxis care among men who have sex with men and transgender women in the United States. J Int AIDS Soc 2019; 22 e25385
| Long-term retention in pre-exposure prophylaxis care among men who have sex with men and transgender women in the United States.Crossref | GoogleScholarGoogle Scholar | 31423756PubMed |
[10] Siegler AJ, Mouhanna F, Giler RM, Weiss K, Pembleton E, Guest J, et al The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis–to-need ratio in the fourth quarter of 2017, United States. Ann Epidemiol 2018; 28 841–9.
| The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis–to-need ratio in the fourth quarter of 2017, United States.Crossref | GoogleScholarGoogle Scholar | 29983236PubMed |
[11] Elopre L, Kudroff K, Westfall AO, Overton ET, Mugavero MJ. The right people, right places, and right practices: disparities in PrEP access among African American men, women and MSM in the Deep South. J Acquir Immune Defic Syndr 2017; 74 56–9.
| The right people, right places, and right practices: disparities in PrEP access among African American men, women and MSM in the Deep South.Crossref | GoogleScholarGoogle Scholar | 27552156PubMed |
[12] Underhill K. Intimacy, condom use, and pre-exposure prophylaxis (PrEP) aceptability among men who have sex with men (MSM) in primary partnerships: a comment on Gamarel and Golub. Ann Behav Med 2015; 49 151–3.
| Intimacy, condom use, and pre-exposure prophylaxis (PrEP) aceptability among men who have sex with men (MSM) in primary partnerships: a comment on Gamarel and Golub.Crossref | GoogleScholarGoogle Scholar | 25245137PubMed |
[13] Myers JE, Sepkowitz KA. A pill for HIV prevention: déjà vu all over again? Clin Infect Dis 2013; 56 1604–12.
| A pill for HIV prevention: déjà vu all over again?Crossref | GoogleScholarGoogle Scholar | 23408681PubMed |
[14] Delany-Moretlwe S, Mullick S, Eakle R, Rees H. Planning for HIV preexposure prophylaxis introduction: lessons learned from contraception. Curr Opin HIV AIDS 2016; 11 87–93.
| Planning for HIV preexposure prophylaxis introduction: lessons learned from contraception.Crossref | GoogleScholarGoogle Scholar | 26575146PubMed |
[15] Higgins JA, Smith NK. The sexual acceptability of contraception: reviewing the literature and building a new concept. J Sex Res 2016; 53 417–56.
| The sexual acceptability of contraception: reviewing the literature and building a new concept.Crossref | GoogleScholarGoogle Scholar | 26954608PubMed |
[16] Higgins JA, Hoffman S, Graham CA, Sanders SA. Relationships between condoms, hormonal methods, and sexual pleasure and satisfaction: an exploratory analysis from the Women’s Well-Being and Sexuality Study. Sex Health 2008; 5 321–30.
| Relationships between condoms, hormonal methods, and sexual pleasure and satisfaction: an exploratory analysis from the Women’s Well-Being and Sexuality Study.Crossref | GoogleScholarGoogle Scholar | 19061551PubMed |
[17] Higgins JA, Ryder K, Skarda G, Koepsel E, Bennett EA. The sexual acceptability of intrauterine contraception: a qualitative study of young adult women. Perspect Sex Reprod Health 2015; 47 115–22.
| The sexual acceptability of intrauterine contraception: a qualitative study of young adult women.Crossref | GoogleScholarGoogle Scholar | 26280666PubMed |
[18] Starks TJ, Rendina HJ, Breslow AS, Parsons JT, Golub SA. The psychological cost of anticipating HIV stigma for HIV-negative gay and bisexual men. AIDS Behav 2013; 17 2732–41.
| The psychological cost of anticipating HIV stigma for HIV-negative gay and bisexual men.Crossref | GoogleScholarGoogle Scholar | 23420102PubMed |
[19] Hojilla JC, Koester KA, Cohen SE, Buchbinder S, Ladzekpo D, Matheson T, et al Sexual behavior, risk compensation, and HIV prevention strategies among participants in the San Francisco PrEP demonstration project: a qualitative analysis of counseling notes. AIDS Behav 2016; 20 1461–9.
| Sexual behavior, risk compensation, and HIV prevention strategies among participants in the San Francisco PrEP demonstration project: a qualitative analysis of counseling notes.Crossref | GoogleScholarGoogle Scholar |
[20] Collins SP, McMahan VM, Stekler JD. The impact of HIV pre-exposure prophylaxis (PrEP) use on the sexual health of men who have sex with men: a qualitative study in Seattle, WA. Int J Sex Health 2017; 29 55–68.
| The impact of HIV pre-exposure prophylaxis (PrEP) use on the sexual health of men who have sex with men: a qualitative study in Seattle, WA.Crossref | GoogleScholarGoogle Scholar |
[21] Koester K, Amico RK, Gilmore H, Liu A, McMahan V, Mayer K, et al Risk, safety and sex among male PrEP users: time for a new understanding. Cult Health Sex 2017; 19 1301–13.
| Risk, safety and sex among male PrEP users: time for a new understanding.Crossref | GoogleScholarGoogle Scholar | 28415911PubMed |
[22] Whitfield THF, Jones SS, Wachman M, Grov C, Parsons JT, Rendina HJ. The impact of pre-exposure prophylaxis (PrEP) use on sexual anxiety, satisfaction, and esteem among gay and bisexual men. J Sex Res 2019; 56 1128–35.
| The impact of pre-exposure prophylaxis (PrEP) use on sexual anxiety, satisfaction, and esteem among gay and bisexual men.Crossref | GoogleScholarGoogle Scholar | 30777781PubMed |
[23] Keen P, Hammoud MA, Bourne A, Bavinton BR, Holt M, Vaccher S, et al Use of HIV pre-exposure prophylaxis (PrEP) associated with lower HIV anxiety among gay and bisexual men in Australia who are at high risk of HIV infection: results from the Flux Study. J Acquir Immune Defic Syndr 2020; 83 119–25.
| Use of HIV pre-exposure prophylaxis (PrEP) associated with lower HIV anxiety among gay and bisexual men in Australia who are at high risk of HIV infection: results from the Flux Study.Crossref | GoogleScholarGoogle Scholar | 31935203PubMed |
[24] Higgins JA, Hirsch JS. Pleasure, power, and inequality: incorporating sexuality into research on contraceptive use. Am J Public Health 2008; 98 1803–13.
| Pleasure, power, and inequality: incorporating sexuality into research on contraceptive use.Crossref | GoogleScholarGoogle Scholar | 18703457PubMed |
[25] Randolph ME, Pinkerton SD, Bogart LM, Cecil H, Abramson PR. Sexual pleasure and condom use. Arch Sex Behav 2007; 36 844–8.
| Sexual pleasure and condom use.Crossref | GoogleScholarGoogle Scholar | 17909960PubMed |
[26] Calabrese SK, Reisen CA, Zea MC, Poppen PJ, Bianchi FT. The pleasure principle: the effect of perceived pleasure loss associated with condoms on unprotected anal intercourse among immigrant Latino men who have sex with men. AIDS Patient Care STDS 2012; 26 430–5.
| The pleasure principle: the effect of perceived pleasure loss associated with condoms on unprotected anal intercourse among immigrant Latino men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 22663165PubMed |
[27] Golub SA, Starks TJ, Payton G, Parsons JT. The critical role of intimacy in the sexual risk behaviors of gay and bisexual men. AIDS Behav 2012; 16 626–32.
| The critical role of intimacy in the sexual risk behaviors of gay and bisexual men.Crossref | GoogleScholarGoogle Scholar | 21630012PubMed |
[28] Carballo-Diéguez A, Ventuneac A, Dowsett GW, Balan I, Bauermeister J, Remien RH, et al Sexual pleasure and intimacy among men who engage in “bareback sex”. AIDS Behav 2011; 15 S57–65.
| Sexual pleasure and intimacy among men who engage in “bareback sex”.Crossref | GoogleScholarGoogle Scholar | 21380496PubMed |
[29] da Silva-Brandao RR, Ianni AMZ. Sexual desire and pleasure in the context of the HIV pre-exposure prophylaxis (PrEP). Sexualities 2020; 23 1400–16.
| Sexual desire and pleasure in the context of the HIV pre-exposure prophylaxis (PrEP).Crossref | GoogleScholarGoogle Scholar |
[30] Mabire X, Puppo C, Morel S, Mora M, Rojas Castro D, Chas J, et al Pleasure and PrEP: pleasure-seeking plays a role in prevention choices and could lead to PrEP initiation. Am J Mens Health 2019; 13 1–14.
| Pleasure and PrEP: pleasure-seeking plays a role in prevention choices and could lead to PrEP initiation.Crossref | GoogleScholarGoogle Scholar |
[31] Gamarel KE, Golub SA. Intimacy motivations and pre-exposure prophylaxis (PrEP) adoption intentions among HIV-negative men who have sex with men (MSM) in romantic relationships. Ann Behav Med 2015; 49 177–86.
| Intimacy motivations and pre-exposure prophylaxis (PrEP) adoption intentions among HIV-negative men who have sex with men (MSM) in romantic relationships.Crossref | GoogleScholarGoogle Scholar | 25124457PubMed |
[32] Brooks RA, Kaplan RL, Lieber E, Landovitz RJ, Lee S-J, Leibowitz AA. Motivators, concerns, and barriers to adoption of preexposure prophylaxis for HIV prevention among gay and bisexual men in HIV-serodiscordant male relationships. AIDS Care 2011; 23 1136–45.
| Motivators, concerns, and barriers to adoption of preexposure prophylaxis for HIV prevention among gay and bisexual men in HIV-serodiscordant male relationships.Crossref | GoogleScholarGoogle Scholar | 21476147PubMed |
[33] Holt M, Lea T, Bear B, Halliday D, Ellard J, Murphy D, et al Trends in attitudes to and the use of HIV pre-exposure prophylaxis by Australian gay and bisexual men, 2011–2017: implications for further implementation from a diffusion of innovations perspective. AIDS Behav 2019; 23 1939–50.
| Trends in attitudes to and the use of HIV pre-exposure prophylaxis by Australian gay and bisexual men, 2011–2017: implications for further implementation from a diffusion of innovations perspective.Crossref | GoogleScholarGoogle Scholar | 30539496PubMed |
[34] Holt M, Lee E, Lea T, Bavinton B, Broady T, Mao L, et al HIV preexposure prophylaxis cascades to assess implementation in Australia: results from repeated, national behavioral surveillance of gay and bisexual men, 2014–2018. J Acquir Immune Defic Syndr 2020; 83 e16–22.
| HIV preexposure prophylaxis cascades to assess implementation in Australia: results from repeated, national behavioral surveillance of gay and bisexual men, 2014–2018.Crossref | GoogleScholarGoogle Scholar | 31913993PubMed |
[35] Ellison J, van den Berg JJ, Montgomery MC, Tao J, Pashankar R, Mimiaga MJ, et al Next-generation HIV pre-exposure prophylaxis preferences among men who have sex with men taking daily oral pre-exposure prophylaxis. AIDS Patient Care STDS 2019; 33 482–91.
| Next-generation HIV pre-exposure prophylaxis preferences among men who have sex with men taking daily oral pre-exposure prophylaxis.Crossref | GoogleScholarGoogle Scholar | 31603712PubMed |
[36] Dhalla S, Poole G. Effect of race/ethnicity on participation in HIV vaccine trials and comparison to other trials of biomedical prevention. Hum Vaccin Immunother 2014; 10 1974–84.
| Effect of race/ethnicity on participation in HIV vaccine trials and comparison to other trials of biomedical prevention.Crossref | GoogleScholarGoogle Scholar | 25424807PubMed |
[37] Castillo-Mancilla JR, Cohn SE, Krishnan S, Cespedes M, Floris-Moore M, Schulte G, et al Minorities remain underrepresented in HIV/AIDS research despite access to clinical trials. HIV Clin Trials 2014; 15 14–26.
| Minorities remain underrepresented in HIV/AIDS research despite access to clinical trials.Crossref | GoogleScholarGoogle Scholar | 24518211PubMed |
[38] Hess KL, Hu X, Lansky A, Mermin J, Hall HI. Lifetime risk of a diagnosis of HIV infection in the United States. Ann Epidemiol 2016; 27 238–43.
| Lifetime risk of a diagnosis of HIV infection in the United States.Crossref | GoogleScholarGoogle Scholar |
[39] Lu M, Safren SA, Skolnik PR, Rogers WH, Coady W, Hardy H, et al Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav 2008; 12 86–94.
| Optimal recall period and response task for self-reported HIV medication adherence.Crossref | GoogleScholarGoogle Scholar | 17577653PubMed |
[40] Štulhofer A, Buško V, Brouillard P. The new sexual satisfaction scale and its short form. In Fisher TD, Davis CM, Yarber WL, Davis SL, editors. Handbook of sexuality-related measures. 3rd edn. New York: Routledge; 2011. pp. 530–2.
[41] Štulhofer A, Buško V, Brouillard P. Development and bicultural validation of the New Sexual Satisfaction Scale. J Sex Res 2010; 47 257–68.
| Development and bicultural validation of the New Sexual Satisfaction Scale.Crossref | GoogleScholarGoogle Scholar | 19629836PubMed |
[42] Šević S, Ivanković I, Štulhofer A. Emotional intimacy among coupled heterosexual and gay/bisexual Croatian men: assessing the role of minority stress. Arch Sex Behav 2016; 45 1259–68.
| Emotional intimacy among coupled heterosexual and gay/bisexual Croatian men: assessing the role of minority stress.Crossref | GoogleScholarGoogle Scholar | 26014824PubMed |
[43] Shepler DK, Smendik JM, Cusick KM, Tucker DR. Predictors of sexual satisfaction for partnered lesbian, gay, and bisexual adults. Psychol Sex Orientat Gend Divers 2018; 5 25–35.
| Predictors of sexual satisfaction for partnered lesbian, gay, and bisexual adults.Crossref | GoogleScholarGoogle Scholar |
[44] Anderson PL, Glidden DV, Liu A, Buchbinder S, Lama JR, Guanira JV, et al Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med 2012; 4 151ra125
| Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 22972843PubMed |
[45] Devarajan S, Sales JM, Hunt M, Comeau DL. PrEP and sexual well-being: a qualitative study on PrEP, sexuality of MSM, and patient-provider relationships. AIDS Care 2020; 32 386–93.
| PrEP and sexual well-being: a qualitative study on PrEP, sexuality of MSM, and patient-provider relationships.Crossref | GoogleScholarGoogle Scholar | 31760759PubMed |
[46] Klatt J, Taylor-Powell E. Synthesis of literature relative to the retrospective pretest design. Presented at the 2005 Joint Canadian Evaluation Society (CES)/American Evaluation Association (AEA) Conference; 29 October 2005; Toronto, Canada. 2005. Available at http://comm.eval.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=31536e2f-4d71-4904-ae5d-056e3280c767
