"Failures of post-exposure prophylaxis following sexual exposure (PEPSE) to prevent seroconversion have been reported and are often associated with ongoing risk exposure," the authors wrote. "Understanding why men who have sex with men (MSM) access PEPSE on some occasions and not others may lead to more effective health promotion and disease prevention strategies." The researchers undertook a qualitative study using semi-structured interviews of 15 MSM within six months of their initiating PEPSE treatment at an HIV outpatient service in Brighton.
Several factors that motivated the men to seek PEPSE were identified: an episode that related to a particular sexual partner and the partner's behavior; characteristics of the location where the risk occurred; the respondent's state of mind, and the influence of alcohol and recreational drug use; and the respondent's perceptions about the effectiveness of PEPSE. "Help was sought in the light of a 'one-off' or 'unusual' event," the authors wrote. "Many respondents felt they were less likely to behave in a risky manner following PEPSE."
In order for PEPSE to function effectively as a public health measure, "at-risk individuals need to be empowered to make improved risk calculations from an increased perception that they could be exposed to HIV if they continue their current behavior patterns," the authors concluded. "The concern is that PEPSE was sought by a low number of MSM implying that a greater number are not using the service based on failure to make accurate risk calculations or recognize high-risk scenarios."