Maxwell, Steven; (2021) Pre-exposure prophylaxis use among men who have sex with men who have engaged in chemsex. Doctoral thesis (Ph.D), UCL (University College London).

Preview

Text PhD thesis final rep pub..pdf - Published Version Download (5MB) | Preview

Abstract

Background: Men who have sex with men (MSM) in the United Kingdom are one of groups most effected by HIV. Due to the multitude of risk behaviours, MSM who engage in chemsex are at heightened risk of acquiring HIV. Pre-exposure prophylaxis (PrEP) reduces the risk of HIV acquisition by up to 99%, although this is dependent on high levels of adherence. There were public health concerns that MSM chemsex behaviour may negatively impact upon PrEP use. The PhD aim was to examine the interface relationship between MSM chemsex engagement and PrEP use. The PhD will inform interventions that improve PrEP uptake/medication adherence amongst MSM who engage in chemsex. Methods: I used multiple methods that adopted a pragmatic approach with a biopsychosocial perspective on health. Firstly, I completed two systematic reviews: MSM chemsex behaviours and MSM PrEP uptake/medication adherence. Secondly, I performed a quantitative analysis of PrEP use among MSM who experienced problematic chemsex. Finally, I completed a qualitative study of PrEP uptake/ medication adherence among MSM chemsex participants. The cascade approach to HIV prevention and perception/practicalities approach (PAPA) to adherence were used to understand the PrEP use journey. Results: MSM chemsex participants were at high risk of HIV acquiring as it involved multiple risk behaviours, including drug and sexual activities. MSM who experienced problematic chemsex were at heightened risk of HIV acquisition which was intertwined with complex psycho-social factors. The wider MSM population had high PrEP adherence levels. Chemsex participants’ motivation to use PrEP was driven by high perceived HIV risk and necessity to protect against the biopsychosocial consequences of an HIV diagnosis. MSM social discourse and norms influenced chemsex participants candidacy for PrEP. PrEP accessibility was facilitated by free and trustworthy sources from dynamic established providers. Generally, chemsex participants had high PrEP adherence levels. However, a sub-group of MSM who experience problematic chemsex may be at heightened risk of non-adherence. MSM used PrEP to contain the impact chemsex had on their health and psychosocial wellbeing. They used multiple strategies in their day to day lives and chemsex context to promote PrEP adherence. Conclusion: MSM chemsex participants were at high risk of HIV acquiring and those that experienced problematic chemsex had increased vulnerability. Chemsex participants' motivation to use PrEP was driven by high-perceived HIV risk and biopsychosocial implications of an HIV diagnosis. Their access to PrEP was facilitated by structural opportunities. Chemsex participants had high PrEP adherence levels but there was increased a risk of non-adherence when behaviours became problematic and/or had a negative impact on health. Multi-level strategies were used to promote adherence to PrEP regimens.

Download activity - last month

Export as CSVJSONXML

Download activity - last 12 months

Export as JSONCSVXML

Downloads by country - last 12 months

Export as XMLJSONCSV

Archive Staff Only

View Item