Between July 2018 and March 2019, we conducted qualitative semi-structured interviews with queer men to understand their experiences accessing and using HIV pre-exposure prophylaxis (PrEP) in Metro Vancouver. We used community-based approaches that engaged young queer men at every step of the research process, and partnered with university researchers who provided mentorship and academic support along the way. We use illustrative de-identified quotes to present the findings from our research in the words of our participants.
Our analyses explored a range of themes and experiences across the PrEP pathway, including: where queer men seek information about PrEP, interactions with healthcare providers, how PrEP affects sexual decision making and harm reduction practices, stigma and HIV-related anxiety, and reasons for stopping PrEP. In doing so, we identified strengths in the current system of care, as well as many important barriers that continue to impeded access to this HIV prevention option.
Participants noted that the public program which provides PrEP at no cost to clients was highly significant in decision making behind using PrEP. Participants also expressed preferences for accessing PrEP at specialized sexual health centres, such as Health Initiative for Men (HIM), which were considered highly culturally competent and convenient.
On the other hand, some participants experienced challenges navigating the public PrEP program, as it was unlike accessing other prescription medications or HIV prevention options. One clinical screening tool used to assess clients for eligibility in the public program was viewed by participants as stigmatizing and disempowering. Participants also noted important challenges when discussing PrEP with their existing healthcare providers, who were sometimes unfamiliar with PrEP or perpetuated stigma in healthcare settings.
When using PrEP, participants described a range of benefits to their mental health and sex lives. In particular, PrEP enabled some participants to have the sex they want and alleviate HIV-related anxiety that may have informed their sexual decision making before PrEP or contributed to HIV-stigma. Some participants also described lower condom use and increased number of sexual partners while using PrEP, although increased testing for HIV and other sexually transmitted infections. Reasons for stopping PrEP included concerns about side effects, entering into a monogamous relationship, or if it were no longer free.
Our report concludes with actionable policy recommendations to improve the system of care for queer men. We call on decision makers to simplify the enrollment process for the public program, to keep PrEP free for queer men in British Columbia and expand access to publicly-funded PrEP across Canada. We call on healthcare providers to address stigma in healthcare settings and to increase awareness about PrEP among primary care providers. This report was written by members of Vancouver’s Investigaytors program, a community-based participatory research program for young queer men.