PrEP May Offer Psychological Benefits, Study Suggests

Pre-exposure prophylaxis (PrEP) use may have psychological benefits for gay and bisexual men, according to a recent study that reported lower sexual anxiety among men who were taking PrEP.

"For many gay and bisexual men, the fear of HIV is still very real, and this fear may be negatively impacting their mental health," Thomas Whitfield, a graduate student at City University of New York and first author of the study, told Contagion^®."PrEP may put some of these men’s minds at ease and allow them to enjoy their sex lives better."

The study, published in The Journal of Sex Research, involved more than 1000 gay and bisexual men throughout the United States who completed a Multidimensional Sexual Self-Concept Questionnaire including 100 items at multiple times before and after beginning their PrEP use.

The study found an average decrease of sexual anxiety by 0.27 points when participants were on PrEP compared with before treatment. No significant changes were reported in sexual esteem or satisfaction.

"To me, one of the most important aspects of these findings is that PrEP might finally provide a turning point for sexual minority men who have spent decades worrying about sexual risk," senior author Jonathon Rendina, PhD, MPH, director of quantitative methods at the Center for HIV Educational Studies & Training, Hunter College of the City University of New York, told Contagion^®.

"Although unintended, the field of HIV prevention led to the notion that we couldn’t trust our sexual partners and that any one act of sex without a condom could have a significant consequence, and one that you wouldn’t be able to for until as many as 3 months,” he continued. “Guys who struggle to use a condom every time or for whom that simply isn’t their choice now have others, and these additional options aren’t just reducing risk, they’re helping men to feel less worried about having sex in the first place."

The study noted that anxiety can persist for months, and that some men avoid HIV testing for fear of a positive result. Addressing that anxiety may be a reason in itself to consider PrEP.

"A lot of focus has been put on HIV risk criteria for starting PrEP, which I think makes sense, but these findings also suggest that simply being worried about HIV risk may be reason enough to put a patient on PrEP," Rendina said. "Assuming we can get access and costs figured out (which is a major assumption), we know PrEP is safe, it’ll reduce any risk should it eventually arise, and it might be what they need to reduce their worries about sex regardless of whether they are objectively at risk."

Along with highlighting other reasons to consider PrEP, the study suggests that patients might benefit from having broader conversations with providers that include psychological aspects.

"Health care providers should ask patients about their fear and anxiety around HIV," Whitfield said. "If a patient has anxiety around HIV but isn’t engaging in HIV risk behaviors, perhaps PrEP isn’t the answer and recommendation of a therapist for anxiety may be. However, for at-risk individuals, PrEP is a great option for prevention and may help to alleviate some sexual anxiety."

Further studies are needed to replicate the results and determine whether anxiety continues to decrease over even longer periods of time, Whitfield said. Further investigations also are needed to examine whether psychological benefits may increase uptake of PrEP.