20th International AIDS Conference - Melbourne, Australia


MOPE254 - Poster Exhibition

'Not a get-out-of-jail-free card': the role of pre-exposure prophylaxis in online discussions of bareback sex by men who have sex with men

E. Daroya

Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia

Background: ''Barebacking'', or anal sex without condoms, is widely recognised as a high-risk activity for HIV transmission among men who have sex with men (MSM). One of the reasons offered for why MSM engage in bareback sex is HIV optimism as a result of medications that have dramatically improved the health of many people with HIV. Recently, a novel biomedical HIV prevention technology known as Pre-Exposure Prophylaxis (PrEP) has been found to reduce HIV transmission if coupled with other prevention measures. While PrEP has been proven to be highly effective in clinical trials, very little research exists that looks at the material effects of PrEP in the lives and sexual practices of MSM. This paper describes preliminary findings from a research project exploring how PrEP and other HIV technologies are understood and utilised by men who regularly engage in sex without condoms.
Methods: Analysis of an online discussion forum on barebacking, where MSM discuss various issues vis-à-vis HIV and barebacking practices was conducted. The data in this paper is drawn from a ''thread'' specifically created to discuss PrEP. Participants are mostly from the USA and the UK.
Results: According to the forum participants, PrEP offers significant protection against HIV infection, leading some men to take more sexual risks. However, they also recognise that PrEP does not eliminate all risks of HIV and STI transmission, especially for those who engage in barebacking. In order for PrEP to be effective, participants emphasise adherence to dosage regimes as well as regular check-ups to monitor its side effects. While PrEP is welcomed as a possible alternative to condoms, accessing it is limited to those who can afford it particularly in the American context.
Conclusions: The results demonstrate that PrEP''s effects extend beyond its primary biomedical purpose of reducing and preventing HIV transmission especially for men who engage in bareback sex. PrEP opens up new possibilities in meaning and sexual culture, such as engaging in more sexually risky activities and obligations related to a dosage regimen. As a new technology in HIV prevention, PrEP''s effects are complex with unintended consequences for how MSM think about sexual risk and condoms.

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