Psychological impact of PrEP: beyond efficacy and cost-effectiveness

Simon Collins, HIV i-Base

The impact of PrEP on quality of life in reducing HIV-related anxiety and more dynamic and fulfilled sex lives is potentially as important as hard endpoints for reduced HIV infections.

Mitzy Gafos presented experiences from using PrEP as part of the UK PROUD study, based on semi-structured interviews with 41 participants.

In addition to reporting behavioural changes, the results gave insight into psychological impact of PrEP.

Many of these imply significant changes in outlooks and approach to life:

“PrEP has replaced fear as the central focus of relationships”.

“The feeling of relief of 25 years of weight, of stress… where every sexual interaction is a wave of risk”.

“Worry obviously ruins the sexual experience … removing that worry… probably improved my life over the past 2 years’.

“For the first time in my life since I started taking it I actually have had sex as I like it – without having this horrible feeling of ‘my god’ after”.

“I was selecting negative [partners]… I am more looking at the person now … not if they’re positive”.

“There is more intimacy not using the condoms and the tablets can prevent me from getting HIV”.

“It gives you the peace of mind the added control of minimising that risk”.

“It’s been very good for my mental health (ADHD) because I’ve not had to associate sex with danger so much which is good”.

“If I wasn’t taking it, sooner or later the inevitable is going to happen”.

“The whole experience has really made me quite liberated”.

“I haven’t changed the way I think because I am taking this pill. Having these pills doesn’t give me an excuse to be more crazy than I already am”.

“There is no marked difference, I was having a huge amount of condomless sex before”.


Overall, these quotes provide insight into the qualitative impact that PrEP can have.

When PrEP had no direct impact on behaviour, this was often because the level of risk was already so high. However, PrEP as a medical intervention was clearly warranted.


Gafos M et al. Experiences and perceptions of PrEP among gay and other men who sex with men (MSM) using PrEP in the PROUD study in England.  IAS 2017, 23–26 July 2017, Paris. Oral abstract TUAC0105.

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