When was the last time you talked to your doctor about your sex life? Not just the bare bones, but things like how you open up to your partner during sex, how much you give and receive and how your orgasms feel. Maybe it feels too personal. Maybe it doesn’t seem relevant. But maybe it could help prevent HIV.
You’ve heard of PrEP—pre-exposure prophylaxis, the use of antiretroviral drugs to prevent HIV. PrEP is extremely effective. But the medical field hasn’t quite figured out how to get PrEP into the hands of people who need it. And part of this may be that conversations about PrEP leave out one important component: sex.
Our heteronormative, sexually repressed society prefers not to talk about two men having sex. Historically, the medical response to HIV has focused on pathologizing queerness rather than embracing people’s actual personal sexual experiences. But what would it look like if we centered sexual satisfaction in the conversation about PrEP? What if we talked about how PrEP actually affects people’s sex lives?
My colleagues and I set out to answer this question by talking to queer men in PrEP care at two clinics in New England. We asked these 108 men 20 questions about their sexual satisfaction both before and after starting PrEP. Men were asked to rate aspects of their sex lives, like “the variety of my sexual activities,” “my mood after sexual activity” and “my emotional opening up in sex,” on a scale from 1 (“not at all satisfied”) to 5 (“extremely satisfied”).
Our findings were conclusive: Queer men are more satisfied with their sex lives after starting PrEP—75% of men surveyed reported an increase in sexual satisfaction. The item where men re-ported the biggest increase in satisfaction was “my ‘letting go’ and ‘surrender.’” And 73% of the men surveyed said PrEP increased their quality of life.
Does this actually matter for HIV prevention? Well, yes. We already knew that sexual satisfaction is a big driving factor for people in other sexual behaviors, like deciding not to use condoms. Increased sexual satisfaction may also motivate people in a positive direction—deciding to go on PrEP.
Leaving sexual satisfaction out of PrEP promotion efforts is a missed opportunity to reach people who would benefit from taking PrEP and haven’t been motivated by other messaging. Medical providers should talk to their patients about the potential benefits of PrEP for their sex lives. Public health organizations should center sexual satisfaction in their activities promoting PrEP. And all of us should push to move the field of HIV prevention forward, in the direction of a queerer, more sex-positive future.
Madeline C. Montgomery, MPH, is a doctoral candidate in the Department of Behavioral and Social Sciences at the Brown University School of Public Health.
Original paper: Madeline C. Montgomery; Jacqueline Ellison; Philip A. Chan; Laura Harrison; Jacob J. van den Berg (2021). “Sexual satisfaction with daily oral HIV pre-exposure prophylaxis (PrEP) among gay and bisexual men at two urban PrEP clinics in the United States: An observational study.” Sexual Health, 14(8), 319–326.