Clinician imaginaries of HIV PrEP users in and beyond the gay community in Australia

Abstract

Through the development and implementation of HIV pre-exposure prophylaxis (PrEP), the characteristics of PrEP users have been configured in a range of ways. Drawing on the concept of ‘imaginaries’, we consider how clinicians imagine PrEP users and related communities. We conducted 28 semi-structured interviews in 2019–2020 with PrEP-providing clinicians based in New South Wales and Western Australia. Participants included general practitioners, sexual health nurses and sexual health doctors. We inductively developed three themes through a reflexive thematic analysis: ‘PrEP users as 99% gay men/MSM’, ‘The informed and connected PrEP user’, and ‘Condom users in the PrEP era’. Participants imagined PrEP users primarily as gay men, and so we focused on how gay community was imagined in relation to PrEP users. Users were imagined as supporting one another to use PrEP effectively, but some were imagined as threatening norms of condom use amongst gay community. Analysing clinician imaginaries of PrEP users reveals insight into how clinicians speculate about and engage with changing community norms related to condom use and accessing PrEP. These imaginaries reveal ongoing tensions about who is believed to be best suited to PrEP, and PrEP’s impact on norms of conduct in imagined biosocial communities like gay men.

Keywords:

• Australia
• condoms
• gay men
• health care provider
• HIV prevention
• qualitative

Acknowledgements

We thank the clinicians who participated in this study and the project’s advisory panel: Ric Chaney, Aaron Cogle, Catherine O’Connor, Vincent Cornelisse, Roanna Lobo, Michael Kidd, Garry Kuchel, Jessica Michaels, Scott McGill, Lewis Marshall, Anna McNulty, Nicolas Parkhill, Jeffrey Post, Shaun Powyer, and Don Smith. We also thank Jake Rance and Stephen Molldrem for their feedback on earlier versions of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 We use ‘cis’ as a shorthand for ‘cisgender’ and ‘trans’ as a shorthand for ‘transgender and gender diverse’.

Additional information

Funding

Anthony K J Smith was supported by a Scientia PhD scholarship and research costs from the Faculty of Arts & Social Sciences, UNSW Sydney. The Centre for Social Research in Health and the Kirby Institute are supported by the Australian Government Department of Health.