Ciência & Saúde Coletiva

cienciaesaudecoletiva.com.br DOI: 10.1590/1413-81232024296.03042023EN

ISSN 1413-8123. v.29, n.6

Users’ expectations of the new pre-exposure prophylaxis 1

for the HIV modalities

FREE THEMES
Mônica Lima de Jesus (https://orcid.org/0000-0002-6666-8463) 1
Maricelly Gómez Vargas (https://orcid.org/0000-0002-2389-7821) 2
Lupicinio Iñiguez-Rueda (https://orcid.org/0000-0002-1936-9428) 3
Emmanuelle Fernandez-Gonzalez (https://orcid.org/0000-0002-7658-4597) 4
Luis Augusto Vasconcelos da Silva (https://orcid.org/0000-0003-0742-9902) 1
José Miguel Cabrera (https://orcid.org/0000-0001-8673-3587) 5
Félix Pérez (https://orcid.org/0000-0002-6799-9272) 5
Jorge Saz (https://orcid.org/0000-0002-8679-634X) 5

Abstract This article aims to discuss the expec-

tations of Homosexual Men, Bisexual Men and a
Transgender Woman, who use or want to use an
oral pre-exposure prophylaxis (PrEP) for the hu-
man immunodeficiency virus (HIV) about PrEP
modalities. Sixteen PrEP users, who are followed
up in the BCN Checkpoint, were interviewed,.
The interviews were audio-recorded, subjected
to thematic categorical analysis within the the-
oretical framework from the praxiographic per-
spective. They are all adapted to the use of daily
oral and event-based PrEP. In relation to the new
PrEP modalities (monthly pill; intramuscular in-
jection every two months; subcutaneous injection
every six months), they are all very receptive to
these possibilities, but they lack information on
the specificities of each and specific assessment
of their needs. Comments about the use of oral
PrEP are positive, and expectations regarding the
new PrEP modalities are visibly high. However,
1
Instituto de Psicologia,
the most important thing for the interviewees is
Universidade Federal da
Bahia. R. Aristides Novis the guarantee that they will have follow-up ap-
197, Federação. 40210-730 pointments to continue taking care of their affec-
Salvador BA Brasil.
tive-sexual health, which is not dependent on the
molije@hotmail.com
2
Universidad de Antioquia. type of PrEP modalities.
Medellín Colombia. Key words Human immunodeficiency virus
3
Universidad Autónoma
(HIV), Pre-exposure prophylaxis (PrEP), Sexual-
de Barcelona. Barcelona
España ly transmitted diseases (STDs)
4
Hospital Clinic. Barcelona
España.
5
BCN Checkpoint.
Barcelona España
Cien Saude Colet 2024; 29:e03042023
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Jesus ML et al.

Introduction modality most preferred among HSH, whereas

preference for daily oral PrEP and PrEP based on
PrEP, a prophylaxis prior to exposure to the hu- events varied according to the age, income and
man immunodeficiency virus (HIV) is a preven- education of the interviewees in each country. It
tion strategy recently incorporated into Spain’s concluded that “public health interventions to
health system, framed within the measures tak- increase awareness and availability of PrEP mo-
en to reduce the number of new HIV cases. This dalities in Latin America were urgent, especially
strategy focuses on taking antiretrovirals, and is among HSH youths with low incomes and educa-
accompanied by medical follow-up in which as- tional levels” 6 (p. 8).
pects related to sexual health and the functioning This article aims to discuss the expectations
of the medication are addressed. The Tenofovir of PrEP users, and those who wish to use oral
Disoproxil fumarate-emricitabine pill, known as PrEP, daily or on demand, regarding the new
PrEP and taken daily or on demand, is the most ways of administering it. The text is organized in
commonly used worldwide. Oral PrEP reduces three parts. In the first, we describe the study’s
the risk of HIV by 99%, as evidenced by studies field work, recruitment strategies, the profiles
conducted by Grov et al.1. Other ways of admin- of the participants, and the type of information
istering it are under study, some in advanced analysis, while presenting the praxiographic per-
phases, and are considered promising for the spective of Mol7 that had led us to consider the
control of HIV2,3 transmission. In general, these use of a pill (object/non-human) and its effects
are not yet available in Spanish public health ser- on affective-sexual practices, experienced in the
vices. However, conducting studies and advanc- context of the stigma and discrimination of the
ing the discussion on new ways of administering HIV pandemic. In the second, we discuss the re-
PrEP is necessary for adequate implementation sults of the interviewees’ expectations of the ways
of combined prevention. According to Zhang et of administering PrEP based on the remarks they
al.4, studies on the use of oral PrEP will be in- present in relation to the changes in their affec-
formative and improve its implementation in the tive-sex life after the use of PrEP. Finally, in the
future. Some alternative ways of administering third, we present the conclusions and contribu-
it, e.g., long-acting injectable (LAI) cabotegravir tions of this study regarding this phenomenon.
PrEP, are already approved in some countries,
and others, e.g., implants and patches with mi-
croneedles are under development (p. 254-255). Method
The World Health Organization5 (p. X) continues
to recommend moderate use of long-acting in- Annemarie Mol was interviewed by Martin et al.8
jectable (LAI) PrEP highlighting that it “can be about her work in the field of health anthropol-
offered as an additional prevention option for ogy, in which she defends that the materiality of
people at substantial risk of HIV infection, as things is as significant as social interactions, for
part of combined prevention approaches”. example, meetings between health professionals
Mansergh et al.3, in the U.S.A., studied the and health users, the prescriptions the former
probability and order of preference of men who give to the latter, and the users’ affective prac-
have sex with men (HSH) regarding daily use tices in their own socio-cultural contexts. Ac-
of PrEP and other ways of administering PrEP cording to Mol, this praxiographic perspective is
(injections every one to three months, oral dos- characterized as resembling a trace or path8 (p.
age on demand (regime 2-1-1 consists of taking 298). Drawing upon the Actor-Red Theory, Mol7
two pills together between 2 and 24 hours before emphasizes that the reality is made/performed
sexual relations), anal or penile gel, or anal sup- through practices, and thus it is historically, cul-
pository). The justification for the study was that turally and materially located, which means that
understanding this matter could better guide “the specificities of the field are very important. A
development of HIV prevention. Darrell et al.2, a practice always happens somewhere, never in all
study in Canada, concluded that the heterogene- places” (p. 298).
ity of preferences with respect to emerging HIV According to this praxiographic premise, one
prevention technologies suggests the importance of the researchers interviewed 17 oral PrEP us-
of developing a variety of PrEP formulations, ers at the CheckPoint Community Centre (BCN
since they could attract other HSH at risk. The Checkpoint), run by peers of the LGBTI+ com-
Torres et al.6 study in Brazil, Peru and Mexico, munity in Barcelona, Catalonia (https://ww.bc-
stated that, in general, injectable PrEP was the checkpoint.com/). During the interviews, there
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Ciência & Saúde Coletiva, 29(6):1-10, 2024

was conversation about their affective-sexual together the dialogic fragments about the inter-
practices with use of the pill and the new ways viewees’ experiences using their current way of
of administering it. What we produced together administering it (daily pill or on demand) and
(the interviewees, the interviewer and the other the new ways not yet available in Spain (e.g., in-
researchers) emerged as “a trace” promoting new tramuscular injection every two months; month-
knowledge on the subject. ly pill; subcutaneous injection every six months).
With Mol7 we understand that expectations The analysis also considers the expectations built
of new ways of administering PrEP can be iden- by the participants of the effects of PrEP on affec-
tified by the description of practices and their in- tive-sex life, which we develop in the first section
teractive networks that enable the co-production of the results to contextualize the before and after
of objects/knowledge. In this direction, we are PrEP use. We used the online questionnaire to
interested in reflecting on the effects of the use of gather certain information from the 17 partici-
the oral pill and the other ways of administering pants, for example, age, education, time using
it in people, assuming that the objects/materials PrEP, socio-economic data, sexual orientation,
have an impact on our lives, since objects are also etc.; it should be clarified that these did not con-
actors in social relations7,8. stitute selection criteria, but simply aided contex-
The users first filled an online questionnaire tualization of their narratives.
about the new ways of administering PrEP. It was At first, among the interviewees, it appeared
sent to those who were currently using PrEP or that all 17 identified themselves as males, but,
close to initiating its use, which were criteria con- during the interview, one declared she was a
sistent with the objective of the study. At the end transgender woman; the latter was not excluded
of the questionnaire, participants could decide from the group, given that the focus of the study
whether or not to receive a phone call inviting was on PrEP use and not on gender identity
them for a face-to-face interview appointment at (Chart 1).
the Centre, where we would seek to deepen the The ages of the participants varied from 26 to
theme. The items covered in the interview were: 60. Two were born at the end of the 60s, four in
experience with PrEP, affective-sexual practices the 70s, eight in 1980, one in the 90s, and two did
in the times of PrEP, knowledge about new ways not answer the question about age. 70.5% are Eu-
of administering PrEP and possibilities of using ropean, of which 58.3% were born in Catalonia,
it. This article focuses on the expectations the in- Spain. As for education, 70.5% of the interview-
terviewees had about their experiences with oral ees had advanced levels, and all finished second-
PrEP and their expectations in relation to the ary school except one that had had only attended
new ways of administering it. primary school. All except one had employment
At random, we entered into contact with at that time. Their salaries varied, most earning
some of them for the second stage of the investi- over €1,000; one earned less than €1,000, three
gation, including all those who were already us- earned more than €3,000, and one did not want
ing PrEP or were interested in it. Among the 21 to answer that question. It should be added that
programed appointments, in three consecutive the study was approved by the Ethics Committee
weeks of August 2022, 17 users turned up, and of Research at the Germans Trias I Pujol Univer-
those who did not informed their various rea- sity Hospital, Catalonia, as well as by the Ethics
sons. The interviews were completely transcribed Committee of the Nursing School in Salvador,
with the Transkriptor software and reviewed Bahía State, Brazil, thus complying with the cur-
for the subsequent thematic categorical analysis rent legislation.
(TCA)9 by the first two authors of this article.
The TCA was carried out in three consecutive
recursive stages (pre-analysis, coding and catego- Results and discussion
rization). The statements were decomposed into
units (sentences) and encoded by the similarities Expectations of affective-sex life
depending on the objective of the analysis. and use of oral PrEP
The analysis material resulted from 387 min-
utes of recording. The most extensive interview The expectations of affective-sex life in times
was 32 minutes and the shortest 11. The tran- of PrEP allowed contextualization of the analy-
scription amounted to 160 pages. Below we will sis of the article’s focus, that is, the new ways of
present the thematic category, “Expectations of administering it. In this regard, it is to be high-
the ways of administering PrEP”, which groups lighted that the majority of the interviewees were
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Jesus ML et al.

Chart 1. Characterization of the participants.

Interviewee Sexual Time using
Age Nationality Education Monthly income (€)
number orientation PrEP
1 Bisexual Over 3 years 35 Venezuelan Secondary education+ 1,000 - 1,499
sixth form
2 Homosexual Over 3 years 48 Spanish University degree 1,000 - 1,499
3 Homosexual On a waiting list 53 Spanish Secondary education+ 1,000 - 1,499
sixth form
4 Bisexual On a waiting list 23 Spanish University degree 2,000 – 2,499
5 Homosexual Over 3 years 31 Spanish University degree 1,500 - 1,999
6 Homosexual Over 3 years 33 Spanish University degree 3,000 or more
7 Homosexual Over 3 years - Spanish Secondary education+ 2,500 - 2,999
sixth form
8 Homosexual Over 3 years - Spanish University degree 2,000 – 2,499
9 Homosexual Over 3 years 37 Spanish University degree 1.500 - 1.999
10 Homosexual 2 - 3 years 48 Argentinian University degree 3,000 or more
11 Homosexual 2 - 3 years 37 Venezuelan University degree 3,000 or more
12 Homosexual Over 3 years 37 Colombian Primary school Preferred not to respond
13 Homosexual 2 - 3 years 44 Spanish University degree 2,000 - 2,499
14 Homosexual 2 - 3 years 36 Argentinian University degree 500 - 999
15 Homosexual 1 - 2 years 35 Argentinian University degree 1,000 - 1,499
16 Homosexual Over 3 years 41 Spanish University degree 2,500 - 2,999
17 Homosexual 2 - 3 years 60 Spanish University degree 1,500 - 1,999
Source: Authors.

taking PrEP on a daily basis, and only two on de- It should be added that the above situation
mand. Thus, all were adapted to the presence of can harm those who practice it. Follow-up is es-
the pill in their day-to- day lives: sential to evaluate potential side effects derived
Look, I’m super strict, so I have my time, at from PrEP, as well as the importance of perform-
lunch, which is good for me, because at night I do ing controls for HIV and other sexually trans-
not like to take it, as it could clash with a party mitted diseases (STDs). It is especially import-
or something [. ..] At noon I’m never partying or ant to rule out an HIV infection before starting
drinking alcohol or anything. Also I have an app PrEP (and also every three months) to prevent
that gives me a reminder to take it, and, once I’ve the virus from generating resistance to the medi-
taken it, I feel at ease (E-15, aged 35). cines. The PrEP use information system in Spain
The experience of the interviewees with PrEP (SiPrEP)10 points out that 13.4% of users in the
was positive, considering the time it had been country had taken it prior to entry into the cur-
available in the health services (2019): 60% had rent program. 66.7% had acquired it online, and
used it more than three years and 33% for two “almost a quarter without medical supervision”
to three years. In the interviews it was noticeable (p. 8). The interviewees suggested that it is nec-
that they had no difficulty taking it, whether on essary for PrEP to reach everyone. E-10, having
a daily basis (13) or on demand (2). One of the evaluated his own experience of feeling protect-
participants shared the daily use pills received by ed, stated:
his partner. Interviewee E-6 and his partner had It’s important for everyone to have access. It’d
autonomously decided to share the pills due to be great, because I know there are people still on
the long waiting list to join the program. Howev- the waiting list. [...] As I have been so well since I
er, as E-6 was not carrying out the recommended started protecting myself with it, I’d really like peo-
monitoring, at the end of the interview, he was ple to have more access to it (E-10, aged 48).
invited to join the program at the earliest possible Among our interviewees, some had also used
date. PrEP before the official implementation by the
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Ciência & Saúde Coletiva, 29(6):1-10, 2024

Spanish health services in 2019. They had bought attention to the fact that PrEP users are frequent-
it on their own online. Two of the interviewees ly asymptomatic for some STDs, as in the case
(E-3 and E-4.) did not use PrEP, but wished to of a study in Germany, where specific actions
do so. Both were included in the PrEP start pro- are suggested to identify and treat them11. This
gram after the interview. All 15 participants, who reinforces the importance of the monitoring of
already used PrEP, were satisfied with this com- PrEP users, which can contribute to an increase
bined prevention strategy. Their remarks were in the registration of the incidence of STDs, thus
mostly positive and they reported changes in promoting opportune diagnosis for subsequent
their affective-sexual experiences, associating it treatment. A study by Jongen et al.12 in Amster-
with freedom, especially the elderly due to their dam, with 366 participants (364 GBHSH men
experiences in other stages of the HIV pandemic. and 2 trans women), followed up every 3 months
Wow! How well I feel now! Full satisfaction! It’s for a year, demonstrated that up to 79% of the
just unfortunate I’ve had to wait so long. It’s been people diagnosed with STDs were asymptomatic.
40 years, right? I have only really started having Among the important topics in the study
full relationships since 55. Other poor fellows are of the HIV pandemic and the advances of pre-
still stuck on the road (E-17, 60 years). vention and treatment biomedicines, the age of
Of course, this is now; Before, if you did some- those using PrEP is a matter that deserves spe-
thing without protection, you always had the fear cific study. Our interviews suggest there operates
of whether or not you could be infected not (E-13, a subtle difference of emphasis on the effects of
44 years). PrEP according to age and/or membership of
The changes in the affective-sex life of the certain generations. The elderly interviewees, in
interviewees can be synthesized by the follow- contrast to those born in the 90s, are more em-
ing aspects: 1) decreased anxiety, guilt and fear phatic about the impact of PrEP on their affec-
of HIV (sexual practices without even thinking tive-sex lives. For some of them, they had nev-
of HIV); 2) increased pleasure; 3) greater peace er enjoyed an emotional-sex life with freedom.
of mind regarding the risk of being infected by Currently aged 60, E-17 spent all his youth under
other STDs. the threat of HIV infection and lived through the
The fear is emphasized in the following nar- time when prevention was focused on abstinence
ratives: and use of condoms. Furthermore, the side ef-
For the next day or two, you suffered a horrible fects of antiretrovirals were significant. Partners
nervousness, that something bad could have hap- and friends were lost. All of this was in sharp
pened to you (E1, aged 35). contrast to the experience of taking PrEP. In his
The main change is that, in my entire life before own words:
taking PrEP, I had never been penetrated without This is why PrEP is synonymous with freedom.
a condom. I was always very strict about this as I would define it as a great step towards the sexual
it had always caused me so much fear [...] (E-15, freedom we had lost with the HIV pandemic, but
aged 35). there is still a long way to go (E-17, 60).
Among the few negative comments associat- We found a counterpoint of E-5, currently
ed with the use of PrEP was the concern about aged 31, who did not experience the peak of the
the presence of other STDs, as exemplified by HIV pandemic:
E-8: Of course, I did not pass through the HIV pan-
The bad part, between inverted commas, demic, in which many people died. That was super
of PrEP for me is that, in the end, you relax, on bad, but the transition to the situation today has
the one hand, but you are exposed to many more been very strong [...] Back then they did not know
things [STDs] (E-8 no age stated). how to attend them. Some were not even attended.
Perhaps E-8 resorted to the inverted commas […] I’m living at a time when a solution is avail-
to refer to “the bad part of PrEP”, because, in a able, but it’s not definitive […] (E-5, aged 31).
medical follow-up, he discovered he had syph- The possibility the youngest have to live in a
ilis, whereas he had thought the “injury” to his stage of the HIV pandemic aided by significant
penis was not a disease. It was indeed syphilis, biomedical advances does not decrease the im-
and he was treated straight away. Without PrEP portance of PrEP in their emotional-sex lives.
follow-up, he might not have realized what it was This is noteworthy. Combined prevention already
and discovered it at a more advanced stage. This allows a certain freedom, often conditional upon
is surely what was suggested by the ambivalence individual ability to seek means to not be infect-
of his “inverted commas.” Some studies attract ed by HIV, or to overcome the harm caused by
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Jesus ML et al.

antiretrovirals for prevention, or to be treated for In the same vein, E-5 (aged 31) shared with us
HIV infection. E-4, aged 23, who is on the PrEP his affective-sexual practices:
waiting list, had his first ever HIV test a little be- Once I left on a crazy trip with friends, and
fore the Covid-19 pandemic. When he came to then came back the day after for my pill (Prophy-
know the NGO, he was not much worried about laxis Post-exposure/PEP). It was because I was
the theme, and, like most interviewees, had had very scared [...]. I had made a fatal mistake, I
sex without condoms and been infected by STDs. came crying all the way [...] (E-5, aged 31).
It is plausible that the other STDs with follow- It would not be improbable to assume that
-ups are more visible than before the use of PrEP. many young people make very crazy trips, but
However, there is a statistically significant corre- they do not have their bodies marked [...] by the
lation between STDs in people who use PrEP and institutional discourses of the political, judicial,
the decrease in condom use. Moreover, in various sanitary, social or economic sphere. These bod-
countries, there is a higher incidence of STDs ies, around the time of the HIV pandemic, were
among HSH that use PrEP13. But the presence marked through signaling, classification, humilia-
of STDs is already a reality in those populations. tion, denial of rights, invisibility or disqualification
However, a more recent study by Trager et al.14 of some needs in relation to others15 (p. 12).
demonstrates that the incidence of STDs in PrEP
users in Australia tends to decrease throughout Expectations of the new ways
the months of use. This is what E-9 illustrates of administering PrEP
about his experience before and after PrEP:
At first, before taking PrEP, I was always prone All the interviewees were well adapted to the
to having gonorrhea and chlamydia. I only had fel- use of oral PrEP, whether daily or on demand,
latio, not risky sex, but now it has changed a little. and narrated some strategies so as not to forget
I don’t know if it has been the PrEP [...] I still get to take it: association with other medicines for
those diseases, but their level has dropped a lot (E- chronic diseases, use of alarms, or always carry-
9, aged 37). ing an extra pill in case they did not return home,
In the words of E-4, who was interested in etc. Below is what the interviewees shared about
using PrEP and was on the waiting list, appeared their routine daily use of PrEP:
to be concerned about catching STDs despite the It does not bother me, as, after breakfast, the
use of PrEP without condom use: pill is right there (E-10, age 48).
I’ve been considering it for a few months (us- Yeah. It’s a pill every night. I just set the alarm.
ing PrEP), because it’s truly something that seems I put 10:00-10:30. Easy! (E-5, aged 31).
interesting to me, right? Yes, it’s true that I had al- In this same sense, E-7 told us the process of
ways had a little interest, not respect, but I think, adapting to the daily oral PrEP. He had begun to
within the gay community, there is sometimes take it at night, but it was incompatible with his
a slightly erroneous use, because when they take routine, so he switched to taking it in the morning:
PrEP, they believe they can freely have sex without What I did so as not forget it again was to
a condom, without protection, and this should not adapt it to my work schedule, that is, by starting to
be so, as, in the end, I don’t know how to say this, take it in the morning as soon as I woke up. With
there is always HIV [...], but then, thinking about this routine it has been much better. I never miss a
it well, I think all the advance that can be made day now (E-7, no age stated).
to prevent something is positive, and if I can […], According to SiPrEP10, there is a low treat-
it would be interesting to benefit from a thing that ment interruption index and high adhesion,
can be good for me (E-4, aged 23). since they indicate that, among the 1,398 regis-
The subtle difference in emphasis between tered users, “PrEP interruptions were identified
generations in relation to PrEP use does not in 126 of them (9.0%). In 101 cases (79.5% of the
mean that younger persons do not experience total interruptions) the participant subsequently
anxiety, guilt, fear or complex feelings when it returned to PrEP consultations ”(p. 13). Bekker
comes to situations of pleasure versus risk of HIV et al. (2022) pointed out that use of the daily pill
infection. E-4 (aged 23) told us: can be a challenge for the youngest group of us-
I started crying a lot, as it was like being ers “due in part to side effects, the risk of short-
stripped of everything, Many years ago, I thought I age and the lack of pill storage options” (p. 1 ).
still didn’t have it. However, in a casual encounter, Thus, these authors highlighted the importance
a boy, living with HIV, told me it was ‘undetectable of evaluating other alternatives for PrEP use to
and non-transmissible’. respond to these demands. Contrary to the re-
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Ciência & Saúde Coletiva, 29(6):1-10, 2024

sults of Bekker et al.16, the study by Torres et al.6 a network of relationships and practices (of the
in Latin America stated that the preference for health professional, the user, sexual acts, infec-
daily PrEP was associated with younger age and tions, etc.), and, as an actor, has the capacity to
lower income in Brazil and Mexico, and also, in influence the actions of other actors .
Brazil only, with a lower educational level . It should be noted that, in the case of our
Regarding the monthly tablet, the interviewees, transgender participant, more medications and
with greater spontaneity, explained their routine various ways of administering them could pres-
experiences of the challenges to maintaining the ent a major challenge. However, she seems to
discipline of daily pill use: have an open disposition to this precisely for
Well, if they offered it to me, I would say yes, having had previous experience of using other
because a monthly PrEP can be forgotten some biotechnologies. Referring to injection, she said:
day. No, you have to take it every day, and it’s a [...] for a long time, the hormone I used was a
chore. You’re partying with friends, and the alarm blister that I would buy in Argentina, was intra-
sounds “10, Wednesday”. So you then need to go muscular, and I had to take it once a month. It was
home (E-5, aged 31). something that I had also undergone at another
In general, doubts and concerns about the time in my life. So, injections are no problem for
new ways of administering PrEP have to do with me (E-14, aged 36).
the uncertainties and lack of information on the In a study similar to ours, Manserg et al.3 ana-
subject, but everyone trusts that they can adapt lyzed the preference for using various prevention
to having something even more compatible with technologies including the daily pill, prolonged
their personal and psycho-social needs. Among action injection, the pill for occasional sex, pe-
the concerns, we were told the following: 1) nile gel and anal suppository. They concluded
doubts about efficacy; 2) the monthly pill has that beyond preferences, what stood out was the
good receptivity, but some think it is more diffi- type of behavior, these being divided into those
cult to control than the daily version, because the based on products dictated by sexual events and
latter is more evident in the routine; 3) injection those not dictated by sexual events. In the study
is also an option that attracts interest, but there by Manserg et al., when questioned about their
are some concerns about the loss of autonomy to preferences, PrEP users tended to choose the
administer it; 4) as for implants, some care about injection taken monthly or every three months,
having some permanent material in their bodies. compared to those who use it on demand or who
However, it is clear in the statements that there do not use it, which explains the concern about
is receptivity in relation to the ways under study, the stress that can be caused by taking it daily or
provided that they fulfil the same function, and if the effect of a minimum dose. This differs from
they are compatible with the need of each person: our results, since our participants do not indicate
So, if everything that is developed is better, in the reasons for interruption of oral PrEP syn-
the end, it’s better for me too. I see no problem in thesized by SiPrEP10: Absence of risk perception
changing (E-13, aged 44). (20%), followed by personal reasons (17.1%); a
Injectable is also interesting, an implant too. As small number of cases due to side effects, for ex-
cream, I don’t know. It seems less attractive, more ample, alteration of the renal function; cessation
for sensations, I don’t know. On balance, it’s prob- of sexual activity due to isolation derived from a
ably better to have a jab or take it orally. Never- situation of pandemic such as COVID-19, stable
theless, these seem very interesting (E-3, aged 53). couple relationships, appearance of diseases unre-
Even though once a month would make me lated to the treatment (p. 13).
afraid, the monthly pill would be more practical. While the interviewees described some con-
However, it has the same effectiveness as taking it cerns and expectations regarding the use of PrEP
every day. I feel that every day you would be pro- irrespective of how it is administered, these do
tecting yourself [...] I believe that the main thing not interfere with adhesion or interest in using
is that I would not be encouraged to do something the new modes. In particular, their condition for
that had just begun, but I know it is validated and I any new use was real patient tracking, as a step
know it works. It seems practical, because, if it were towards a more feasible solution to make HIV dis-
once a month, I would have to remember. So I really appear (E-9, aged 37). This is also stated by E-7
find the daily dose more practical (E-15, aged 35). (no age stated) indicating with respect to injec-
These challenges that suppose the use of new tion that This would be a great advantage provided
objects exemplify what the praxiographic per- that the analyses were maintained. I really see this
spective7 explains. In this case, PrEP is part of as very positive. On the other hand, E-8 (no age
 8
Jesus ML et al.

stated) insisted on the matter of how checking is perception that the users will feel safe and pro-
conducted, showing that there is a posture more tected if they have the follow-up in the context
interested in continuous monitoring than in the of the Community Centre and in public health
type of biotechnology that prevents HIV. services, which is similar to what is raised in a
study by Brooke et al.17 on the positive monitor-
ing effects carried out with medical care for the
Conclusions LGBTQ collective. Systematic monitoring, which
has a fundamental function at this time of im-
Among our interviewees, there was satisfaction plementation, is necessary to reduce new HIV
regarding the use of PrEP, both on a daily ba- infections and head toward their eradication, at
sis and on demand, when there are outstanding least until PrEP coverage reaches all of this popu-
positive repercussions for their emotional-sexual lation group, and also has the capacity to provide
lives, characterizing that there is greater freedom protection against other STDs.
and decreased fear and anxiety about HIV in- In conclusion, it follows that the most im-
fection; according to their responses, there were portant thing for those who use PrEP, or are in-
also positive expectations about the new ways of terested in it, is the guarantee that they will have
administering PrEP. The male interviewees and follow-up to continue taking care of their emo-
the female interviewee manifested their interest, tional-sexual health, that is, the type of follow-up
expressing their hope to be able to use them in implemented by the PrEP program, both in the
the near future, according to their needs. This public health services and in the community
reaction coincided with the HSH in some other center that monitored it. This important aspect
studies2-3-6. This study takes into account Mol’s does not depend on the way of administering it
praxiographic perspective that prioritizes the in- in the sense that the different ways will be made
teraction of people with objects and institutions. available and will be determined by specific eval-
However, as its objective was to understand the uation of the requirements of each of them. This
expectations about these new ways, not yet offered suggests that expansion of the supply of daily pills
or well established in Spain, future studies are ex- and those on demand, reduction of waiting lists
pected to investigate relationships with these new and new ways of administering it, will be import-
objects. These studies could also describe in more ant for the success of this combination. As this
detail the ways these technologies, in interaction aspect of monitoring was not emphasized in the
with other actors, will produce multiple realities. scarce psycho-social studies of reference found
In our study, this availability of new ways on the subject, it constitutes one of the main con-
of administering PrEP is accompanied by the tributions made by this article.
 9

Ciência & Saúde Coletiva, 29(6):1-10, 2024

Collaborations Acknowledgments

M Lima and LAV Silva contributed to the concep- Acknowledgments: We wish to express our grati-
tion, writing and final revision. M Gómez-Vargas tude to the colleagues of our research groups, the
contributed with the methodology, writing and Laboratório de Estudos Es Mental (Lev) of Uni-
final review. L Iñiguez-Rueda, E Fernandez-Gon- versidade Federal da Bahia, LAICOS/IAPSE of
zalez, JM Cabrera, F Perez and J Saz contributed the Barcelona Autonomous University (UAB) for
with the final review. the critical readings of the text’s initial versions,
and Universidade Federal da Bahia for granting
leave to the first author from the UAB to pursue
a post-doctorate.

Funding

Conselho Nacional de Desenvolvimento Cientí-

fico e Tecnológico (CNPq).
 10
Jesus ML et al.

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