"It's been a very liberating experience": doxycycline post-exposure prophylaxis (doxy-PEP) for STI prevention and experiences with sexual pleasure by men who have sex with men (MSM)

Abstract

Background: Pleasure is a key component in sexual decision-making. Doxycycline postexposure prophylaxis (doxy-PEP) is a novel intervention for STI prevention for MSM that may influence sexual experiences. Using the Sexual Health Model, we assessed whether doxy-PEP use influences intimacy and sexual pleasure among MSM.

Methods: From November 2021 through December 2022, we conducted individual interviews with MSM living with and without HIV enrolled in a clinical trial of doxy-PEP (NCT03980223). Participants were purposively sampled to capture a range of doxy-PEP use frequency. Interviews explored how doxy-PEP influenced sexual health and decision-making, pleasure, intimacy, and relationships. Interview transcripts and debrief reports were thematically analyzed.

Results: We interviewed 43 DoxyPEP trial participants, of whom the median age was 38 years (IQR 34-46), 63% identified as white, 18% as Black, and 38% as Hispanic. Nineteen (44%) were living with HIV. Participants reported that doxy-PEP use improved their quality of life by providing peace of mind and resulted in more enjoyable sex experiences and increased intimacy. Participants felt doxy-PEP provided freedom to choose about condom use and selection of partners, and supported communication with sexual partners about STI prevention. These positive experiences with doxy-PEP were similar in men living with and without HIV.

Conclusion: MSM reported that doxy-PEP use improved their sexual pleasure and intimacy with partners. Recognizing these positive aspects of doxy-PEP is essential for tailoring messaging and counseling about doxy-PEP and could motivate doxy-PEP use.

Keywords: Doxy-PEP; HIV PrEP; HIV post-exposure prophylaxis; MSM; STIs; pleasure.