Gay and bi men who use PrEP to avoid HIV may take slightly fewer illicit drugs and have lower sexual compulsivity.
That’s the finding of a new study in the Netherlands. Researchers tracked men who were on PrEP and who used Amsterdam’s largest STI clinic over three years.
They found the men generally had the same levels of depression and anxiety. Moreover, alcohol use didn’t change.
However, the PrEP users did end up with significantly lower use of two drugs – ecstasy or MDNA and nitrites or poppers. Likewise, their levels of sexual compulsivity decreased very significantly.
Sexual compulsivity is another name for hypersexuality or sexual addiction. It is when you have sexual fantasies, urges or behaviors that are out of control, causing distress or damaging your health, job, relationships or other parts of your life.
PrEP users ‘more in charge of their sexual behaviour’
Before taking PrEP, 20% of the men had a depressive or anxiety disorder. That compares to 10.5% of Dutch people in general. Meanwhile 38% used drugs in a problematic way, 28% had problematic drinking and 23% had some degree of sexual compulsivity.
The researchers found that depression, anxiety and problematic drinking all went down slightly for people taking PrEP. But the drop wasn’t big enough for them to be sure it was statistically significant.
However, the drop in drug use was significant – from 38% to 31%. Meanwhile the fall in sexual compulsivity was even greater – from 23% to 10%.
Likewise, 18% of men who had at least one of the problems before taking PrEP didn’t have one at the end of the study.
Moreover the PrEP users generally became a lot less worried about acquiring HIV.
PrEP is, of course, a relatively new but very effective way to prevent HIV even while having sex without condoms. Users can take the tablets daily or with a special ‘on-demand’ regimen.
When the drug first became available, some healthcare workers and gay and bi men worried that PrEP users may take more risks with sex.
They warned this could lead to higher levels of sexual compulsivity, substance use, not to mention STIs. This would then result in worse mental health problems.
Indeed the researchers at AmPrEP, the Amsterdam-based PrEP project running the study, said:
‘The simultaneous decrease in drug use disorder and sexual compulsivity was unexpected.’
Analysing the study for AIDS Map Gus Cairns writes:
‘They hypothesise that PrEP relieved its users of the anxiety of catching HIV and that, in turn, this made them feel more in charge of their sexual behaviour (so less compulsive) and less in need of drugs to counteract the inhibiting effect of anxiety.’
Extra STI testing
Likewise, one extra advantage of PrEP is that users usually go for regular STI checks – typically every three months.
This gives healthcare workers the chance to test and treat any other sex infections. It may also help gay and bi men take more interest in their sexual health and feel more empowered.
Matthew Hodson, executive director of NAM, told GSN that the link between PrEP and getting STIs is complicated:
‘Of course, condom use is lower among people who use PrEP. As a result, people may be more likely to contract STIs.
‘However, the picture is more complex than it first appears as if they are on PrEP they are more likely to be actively involved in sexual health services so are more likely to be diagnosed.
‘It’s really important to stress that STIs such as gonorrhea are very easy to go undetected if they are not tested for.’
Meanwhile, Hodson says, the evidence now suggests that gay and bi men started to move away from condoms not because PrEP became available but because scientists worked out how to treat HIV effectively.
He added: ‘The people who use PrEP generally are people who would be having unprotected sex without PrEP. So I welcome and celebrate that gay and bisexual men are taking control of their sexual health.’