A De Montfort University Leicester (DMU) professor and his PhD student have urged the medical profession and media to change the way in which a new HIV prevention treatment is represented if they want it to work.
Professor Rusi Jaspal carried out the first study to find out what men in the UK felt about PrEP – a new HIV prevention treatment said to reduce the risk of infection by 86% if taken daily.
He found that men who would benefit most from taking PrEP were being put off by its association with “high risk” people – as they did not want to place themselves in this category.
The article, published in Cogent Medicine, illustrates how misconceptions and fear of social stigma is hindering the fight against HIV/AIDS in the UK.
Prof Jaspal called on the medical profession and media to do more to improve perceptions and understandings of the potentially life-saving drug.
He said: “The bottom line is that PrEP works. If we are serious about wanting to prevent HIV infections, we need to roll out PrEP to those at highest risk of infection. This needs to be coupled with awareness-raising and stigma reduction. Many people misunderstand PrEP and believe that it’s only for ‘promiscuous people’. This is misleading. Our research clearly shows that the biggest barrier to accessing PrEP is the stigma that often underpins it. We must challenge this.”
Men who have sex with men (MSM) are the group most affected by HIV in the UK. Around 45,000 MSM were living with HIV in the UK in 2014.
Pre-exposure prophylaxis (PrEP) is a novel HIV prevention option which has been available in America since 2012 and is in clinical trials in the UK. Prof Jaspal’s study involved in-depth qualitative individual and focus group interviews with MSM, comprising HIV-positive and HIV-negative individuals. The interviewees were asked about their views on PrEP in terms of their knowledge of the treatment and their feelings towards it.
They found that many were unconvinced by its efficacy as a method of protection. Some said they would not use condoms consistently while taking PrEP, which is recommended given that PrEP does not provide protection against other sexually transmitted infections (STIs).
Many people said they would feel stigmatised at the idea of being “high risk” by taking PrEP. It also highlighted a general lack of understanding about what constituted high-risk activities.
One HIV-negative participant said he thought PrEP would not benefit him because he did not perceive himself as “high-risk”, despite reporting multiple condomless sexual encounters, because he was not “Someone who is out at chemsex parties every weekend.”
Other participants made reference to the stigmatising label “Truvada Whore”, namely someone who engages in frequent reckless sexual behaviour because they believe they are made safer by taking PrEP. The authors said this reflected negative press reporting of the treatment, leading ultimately to ‘individuals perceiving the treatment as a potentially viable HIV prevention tool at a population level, but unsuitable for themselves personally.
The study’s co-author Christos Daramilas, a PhD researcher in sexual health psychology said: “PrEP would benefit various groups in society, not just MSM. PrEP could also facilitate what we call ‘serodiscordant relationships’, that is, relationships between people who do not have the same HIV status, because it provides both physical and psychological protection.”
The authors also argued that perceptions of PrEP would only change if healthcare professionals and the media altered their approach to representing the treatment. They said it would be more effective to present PrEP as a “further level of protection” against HIV, in addition to condoms and other prevention strategies.