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HIV Pre-Exposure Prophylaxis (PrEP) may provide psychosocial benefits beyond its intended purpose of reducing HIV infection. We explore the psychosocial impact of oral PrEP use on gay men in England using qualitative data from the PROUD study. From February 2014 to January 2016, semi-structured in-depth interviews were conducted with 40 gay men and one trans woman. Participants were purposively recruited based on trial arm allocation, adherence, and sexual risk behaviours. By removing HIV risk from sex, PrEP improves users\u2019 wellbeing by reducing HIV-related anxiety and internalised stigma and increasing HIV prevention self-efficacy, sexual pleasure, and intimacy. In turn, these psychological changes may influence behaviour in the form of greater sexual freedom, reduced harmful drug use, and more protective sexual health behaviours. However, PrEP may create internal conflict for some gay men, due to its disruption of social norms around condom use and its perceived influence on their sexual behaviour leading to reduced condom self-efficacy. These findings provide a baseline of PrEP\u2019s psychosocial impact amongst some of the first PrEP users in England and supports calls to consider the psychosocial impact of PrEP in prescribing guidelines.<\/jats:p>","DOI":"10.1186\/s12981-023-00568-2","type":"journal-article","created":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T10:02:44Z","timestamp":1699956164000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["\u201cSex without fear\u201d: exploring the psychosocial impact of oral HIV pre-exposure prophylaxis on gay men in England"],"prefix":"10.1186","volume":"20","author":[{"given":"Rosalie","family":"Hayes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Will","family":"Nutland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Rayment","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonali","family":"Wayal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanesa","family":"Apea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Clarke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"McOwan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Sullivan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Desai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Jajja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Rice","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"Horne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheena","family":"McCormack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitzy","family":"Gafos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,11,14]]},"reference":[{"issue":"1","key":"568_CR1","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/1471-244X-8-70","volume":"8","author":"M King","year":"2008","unstructured":"King M, Semlyen J, Tai SS, Killaspy H, Osborn D, Popelyuk D, et al. 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Differing experiences with Pre-Exposure Prophylaxis in Boston among Lesbian, Gay, Bisexual, and Transgender specialists and generalists in primary care: implications for Scale-Up. AIDS Patient Care STDs. 2017;31(7):297\u2013304.","journal-title":"AIDS Patient Care STDs"},{"issue":"7","key":"568_CR56","doi-asserted-by":"publisher","first-page":"e40603","DOI":"10.1371\/journal.pone.0040603","volume":"7","author":"EA Arnold","year":"2012","unstructured":"Arnold EA, Hazelton P, Lane T, Christopoulos KA, Galindo GR, Steward WT, et al. A qualitative study of provider thoughts on implementing Pre-Exposure Prophylaxis (PrEP) in clinical settings to prevent HIV infection. PLoS ONE. 2012;7(7):e40603.","journal-title":"PLoS ONE"},{"issue":"691","key":"568_CR57","doi-asserted-by":"publisher","first-page":"84","DOI":"10.3399\/bjgp20X708017","volume":"70","author":"DP Gray","year":"2020","unstructured":"Gray DP, Dineen M, Sidaway-Lee K. The worried well. Br J Gen Pract. 2020;70(691):84\u20135.","journal-title":"Br J Gen Pract"},{"key":"568_CR58","doi-asserted-by":"crossref","unstructured":"Gaspar M, Salway T, Grace D. Ambivalence and the biopolitics of HIV pre-exposure prophylaxis (PrEP) implementation. Social Theory & Health; 2021.","DOI":"10.1057\/s41285-020-00154-w"}],"container-title":["AIDS Research and Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12981-023-00568-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12981-023-00568-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12981-023-00568-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T10:05:16Z","timestamp":1699956316000},"score":1,"resource":{"primary":{"URL":"https:\/\/aidsrestherapy.biomedcentral.com\/articles\/10.1186\/s12981-023-00568-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,14]]},"references-count":58,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["568"],"URL":"https:\/\/doi.org\/10.1186\/s12981-023-00568-2","relation":{},"ISSN":["1742-6405"],"issn-type":[{"value":"1742-6405","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,14]]},"assertion":[{"value":"12 October 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 September 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 November 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The PROUD study provided drug free of charge by Gilead Sciences plc. which also distributed it to participating clinics and provided funds for additional diagnostic tests for HCV and drug levels. SMc reports grants from the European Union H2020 scheme, EDCTP 2, the National Institute of Health Research, and Gilead Sciences; other support from Gilead Sciences, and the Population Council Microbicide Advisory Board; and is Chair of the Project Advisory Committee for USAID grant awarded to CONRAD to develop tenofovir-based products for use by women (non-financial). AS\u2019s organisation has received Gilead fellowships in the past. The remaining authors have no competing interests to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The PROUD study protocol was approved by London Bridge Research Ethics Committee, the Medicines and Healthcare Products Regulatory Agency and each of the 12 participating Hospital Trusts. The trial is registered with ISRCTN (Number ISRCTN94465371) and ClinicalTrials.gov (NCT02065986).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Written informed consent was obtained from all individual participants included in the study at enrolment into the trial and prior to in-depth interview. The study protocol, including participant information sheet (PIS) and informed consent form (ICF), and the in-depth interview PIS, ICF and interview guide, are available on the study website (\n                      \n                      ).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate and for publication"}}],"article-number":"81"}}