{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T16:52:18Z","timestamp":1790527938247,"version":"4.1.0"},"reference-count":51,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2018,11,26]],"date-time":"2018-11-26T00:00:00Z","timestamp":1543190400000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2018,11]]},"abstract":"Abstract<\/jats:title>Introduction<\/jats:title>Notwithstanding the efficacy of oral pre\u2010exposure prophylaxis (PrEP<\/jats:styled-content>) in clinical trials, a number of obstacles exist to achieving population\u2010level impact among gay, bisexual and other men who have sex with men (GBM<\/jats:styled-content>). However, few studies have explored the subjective experiences of GBM<\/jats:styled-content> PrEP<\/jats:styled-content> users and non\u2010users in the community, outside of clinical trials. The objectives of this study were to explore GBM<\/jats:styled-content>'s experiences of considering, accessing and using (or not using) PrEP<\/jats:styled-content>, and to understand emerging sexual health, social and community issues among GBM<\/jats:styled-content> in the PrEP<\/jats:styled-content> era.<\/jats:p><\/jats:sec>Methods<\/jats:title>From October 2015 to March 2016, we purposively sampled PrEP<\/jats:styled-content>\u2010na\u00efve and PrEP<\/jats:styled-content>\u2010experienced GBM<\/jats:styled-content> from community organizations and health centres in Toronto, Canada. In\u2010depth, 45\u2010 to 90\u2010minute semi\u2010structured interviews explored PrEP<\/jats:styled-content> perspectives and decision\u2010making, access, initiation, use over time, sexual practices and psychosocial considerations. Interviews were recorded, transcribed verbatim, uploaded into NVIVO<\/jats:styled-content>, reviewed using thematic analysis and then contrasted with the PrEP<\/jats:styled-content> cascade.<\/jats:p><\/jats:sec>Results<\/jats:title>Participants included PrEP<\/jats:styled-content> users (n\u00a0=\u00a015) and non\u2010users (n\u00a0=\u00a014) (mean age\u00a0=\u00a036.7\u00a0years; SD<\/jats:styled-content>\u00a0=\u00a08.2), largely gay\u2010identified (86.2%), cisgender male (89.7%) and white (79.3%). Themes indicate not only correspondences, but also limitations of the PrEP<\/jats:styled-content> cascade by complicating a user\/non\u2010user binary and challenging the unilateral presupposition that HIV<\/jats:styled-content> risk perception leads to PrEP<\/jats:styled-content> acceptance. Findings further call into question assumptions of a linear stage progression and retention in care as a universal endpoint, instead revealing alternate trajectories of seasonal or intermittent PrEP<\/jats:styled-content> use and, for some, an end goal of terminating PrEP<\/jats:styled-content>. GBM<\/jats:styled-content>'s narratives also revealed potent psychological\/affective experiences of untethering sex from HIV<\/jats:styled-content> anxiety; multifaceted PrEP<\/jats:styled-content> stigma; and challenges to sexual norms and practices that complicate existing behavioural prevention strategies and sexual and social relationships.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>An expanded PrEP<\/jats:styled-content> cascade should consider alternate trajectories of use based on dynamic relationships and behavioural risks that may call for seasonal or intermittent use; systemic barriers in access to and sustaining PrEP<\/jats:styled-content>; and multiple end goals including PrEP<\/jats:styled-content> maintenance and discontinuation. Incorporating GBM<\/jats:styled-content>'s lived experiences, evolving preferences, and psychosocial and community\u2010level challenges into PrEP<\/jats:styled-content> implementation models, rather than a circumscribed biomedical approach, may more effectively support HIV<\/jats:styled-content> prevention and GBM<\/jats:styled-content>'s broader sexual and psychological health.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25211","type":"journal-article","created":{"date-parts":[[2018,11,26]],"date-time":"2018-11-26T09:20:21Z","timestamp":1543224021000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Clinical exigencies, psychosocial realities: negotiating HIV pre\u2010exposure prophylaxis beyond the cascade among gay, bisexual and other men who have sex with men in Canada"],"prefix":"10.1002","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0444-5915","authenticated-orcid":false,"given":"Peter A","family":"Newman","sequence":"first","affiliation":[{"name":"Factor\u2010Inwentash Faculty of Social Work University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1380-2016","authenticated-orcid":false,"given":"Adrian","family":"Guta","sequence":"additional","affiliation":[{"name":"School of Social Work University of Windsor Windsor ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0682-8549","authenticated-orcid":false,"given":"Ashley","family":"Lacombe\u2010Duncan","sequence":"additional","affiliation":[{"name":"Factor\u2010Inwentash Faculty of Social Work University of Toronto Toronto ON Canada"},{"name":"School of Social Work University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suchon","family":"Tepjan","sequence":"additional","affiliation":[{"name":"Factor\u2010Inwentash Faculty of Social Work University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,11,26]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001145"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.4683"},{"key":"e_1_2_9_4_1","unstructured":"AVAC.PrEPWatch. n.d. 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