How Male Sex Workers and Their Clients Shifted from Reluctance About HIV Pre-exposure Prophylaxis to Advocating for Its Use: A Longitudinal Mixed Methods Study

AIDS and Behavior
James MacGibbonDenton Callander

Abstract

We assessed individual and collective responses to HIV pre-exposure prophylaxis ('PrEP') among a network of male sex workers and clients. From 2011 to May 2017, keyword searches on an online discussion forum identified 668 posts that referenced PrEP. We conducted four analyses: (i) discourse analysis identifying reactions to PrEP, (ii) thematic analysis constructing rhetorical strategies, (iii) content analysis comparing discursive positions and rhetorical strategies, and (iv) longitudinal analyses assessing trends over time. Forum posts adopted one of three discursive positions (reluctance, interest, advocacy), drawing upon four non-exclusive strategies (deference to experts and evidence, acknowledging personal and shared experiences, establishing philosophical arguments, engaging in speculation). Posts from sex workers were more likely than clients to be supportive of PrEP (96% vs. 42%; χ2 = 18.46, p < 0.001) while over time this network moved from being predominantly reluctant about PrEP (61% of posts in 2012) to advocating for its use (65% of posts in 2017; Z = 5.01, p < 0.001).

References

Nov 26, 2010·The New England Journal of Medicine·Robert M GrantUNKNOWN iPrEx Study Team
Jul 26, 2014·Lancet·Chris BeyrerSteffanie A Strathdee
Nov 26, 2015·Current Opinion in HIV and AIDS·Gus CairnsJean-Michel Molina
Oct 7, 2016·AIDS Education and Prevention : Official Publication of the International Society for AIDS Education·Dawn K SmithKaren W Hoover
Oct 25, 2016·The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine·UNKNOWN Society for Adolescent Health and Medicine
Dec 23, 2016·AIDS and Behavior·Martin Holt

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Citations

Mar 30, 2020·Scientific Reports·William C GoedelKatie B Biello
Oct 28, 2021·AIDS and Behavior·Anne E SundelsonKarolynn Siegel

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