Abstract:
This study explored the sexual behaviours of gay men who use pre-exposure prophylaxis (PrEP) in Gauteng, South Africa, through the perspectives of Erving Goffman’s stigma theory and Berger and Luckmann’s social constructionism theory. Employing these two theories, the study examined how sexual identities and the stigma associated with human immunodeficiency virus (HIV) and PrEP influence the sexual behaviours and decision-making processes of gay men. Consequently, the study explored the stigma and related barriers to accessing PrEP and its influence on sexual behaviours of gay men. Data were collected through in-depth interviews with 10 gay men in the Gauteng province of South Africa. The key findings are presented through three major themes. The first theme highlights the prevalence of risky sexual behaviours among most gay men who take PrEP, including condomless sex and multiple sexual partners, both before and after initiating PrEP. The second theme underscores that PrEP does not solely dictate sexual behaviour; rather, many participants continued to use it alongside other HIV-prevention strategies, such as condoms. The third theme addresses the stigma related to PrEP and uncovers the ongoing experiences of shame and negative labelling by friends, family, partners, healthcare professionals, and society as a whole. Overall, the study reveals a complex interaction between PrEP uptake, sexual behaviours, and stigma. While PrEP serves as an important method of HIV prevention, its impact varies among the gay men who use it. The persistent stigma surrounding PrEP highlights the urgent need for targeted education and awareness, continuous screening for sexually transmitted infections, and stigma-reduction initiatives to support and encourage informed and safe sexual health practices by gay men. The limited data available suggest that research focusing exclusively in gay men who take PrEP has not been sufficiently explored in South Africa. This research contributes to the body of knowledge on how PrEP affects various aspects of the lives of men who identify as gay and thus contributes by enhancing existing HIV-prevention methods. In addition to the wider prevention strategies, the research proposes how the methods can be better tailored for gay men. Additionally, the study also proposes a number of strategies to address various stigmas and social challenges faced by gay men who take PrEP. Based on the findings, recommendations were developed to inform strategies for HIV prevention, advance awareness and education in communities, reform healthcare practices, and influence health policy in inclusive and affirming ways.
