PrEP use was associated with greater sexual esteem and satisfaction among sexual minority men, with perceived HIV risk serving as a significant mediator, suggesting public health messaging should highlight the psychosexual benefits of using PrEP.
Key Findings
Results
Sexual minority men who used PrEP reported greater sexual esteem and satisfaction compared to those who did not use PrEP.
Participants (n=351) were recruited via hookup apps and social media for an online survey conducted in 2019-2020.
PrEP use was a significant direct predictor of both sexual esteem and sexual satisfaction outcomes.
Most participants were cisgender (99.70%) and White (71.22%), limiting generalizability.
PrEP use and U=U belief were positively correlated with each other and both were negatively correlated with perceived HIV risk.
Results
Perceived HIV risk served as a significant mediator between PrEP use and all three psychosexual health outcomes (sexual anxiety, sexual esteem, and sexual satisfaction).
Indirect paths from use of PrEP (vs. non-use) through perception of lower HIV risk were significant relative to all three outcomes.
PrEP use was negatively correlated with perceived HIV risk, meaning PrEP users perceived themselves as less at risk for HIV.
The mediation model tested three psychosexual outcomes: sexual anxiety, sexual esteem, and sexual satisfaction.
The study design was cross-sectional (online survey), which limits causal inference.
Results
Belief in Undetectable=Untransmittable (U=U) was not a significant direct or indirect predictor of psychosexual health outcomes.
U=U belief was negatively correlated with perceived HIV risk.
Neither the direct effect of U=U belief nor the interaction of U=U belief and PrEP use was a significant predictor of sexual anxiety, sexual esteem, or sexual satisfaction.
U=U belief was positively correlated with PrEP use.
The lack of significant U=U findings may reflect the relatively early period of U=U awareness at the time of data collection (2019-2020).
Background
Sexual minority men represent more than 50% of individuals living with HIV in the USA despite comprising less than 5% of the general population.
This disparity frames the study's focus on biomedical prevention interventions for this population.
The study examined HIV-negative or status-unknown SMM specifically.
Biomedical interventions examined included PrEP use and awareness/belief in U=U.
Results
The interaction between U=U belief and PrEP use was not a significant predictor of any psychosexual health outcome.
The study specifically tested the interaction term of U=U belief × PrEP use as a predictor of psychosexual health.
Neither the interaction nor U=U belief alone produced significant direct or indirect effects on sexual anxiety, sexual esteem, or sexual satisfaction.
This suggests that the psychosexual benefits observed were attributable specifically to PrEP use rather than to the combination of PrEP and U=U belief.
Conclusions
The authors recommend that public health messaging and healthcare settings highlight the psychosexual benefits of using PrEP.
The findings suggest PrEP's benefits extend beyond biomedical HIV prevention to include psychosexual wellbeing.
The authors specifically note sexual esteem and sexual satisfaction as psychosexual domains that may benefit from PrEP use.
The pathway through reduced perceived HIV risk identified in the mediation analysis provides a mechanism for these psychosexual benefits.
The sample was predominantly White (71.22%) and cisgender (99.70%), which the authors note as a limitation for broader public health applications.
What This Means
This research suggests that taking PrEP (a daily pill that prevents HIV infection) is associated with better sexual wellbeing among gay, bisexual, and other sexual minority men in the United States. Specifically, men who used PrEP reported higher sexual self-esteem and greater sexual satisfaction compared to men who did not use PrEP. The study, which surveyed 351 men recruited through dating apps and social media in 2019-2020, found that this relationship worked partly because PrEP users felt less personally at risk of getting HIV, and that lower sense of risk was linked to better sexual health across all three outcomes measured: sexual anxiety, sexual esteem, and sexual satisfaction.
Interestingly, simply believing in the U=U (Undetectable=Untransmittable) principle — that a person with HIV who is on effective treatment cannot sexually transmit the virus — was not independently linked to better sexual wellbeing in this study. This may partly reflect the time period of data collection (2019-2020), when U=U awareness was still relatively new and emerging. The sample was predominantly White and cisgender, which limits how broadly these findings can be applied to all sexual minority men.
This research suggests that biomedical HIV prevention tools like PrEP may offer benefits beyond just preventing infection — they may also improve how people feel about their sexuality and sexual lives. The authors suggest that public health campaigns and healthcare providers could do more to communicate these psychosexual benefits of PrEP, potentially motivating more people to use it and improving overall sexual wellbeing in this community.
Modrakovic M, Kalwicz D, Zea M, Forssell S, Dovidio J, Eaton L, et al.. (2025). The Implications of HIV Biomedical Prevention for Perceived HIV Risk and Psychosexual Health among Sexual Minority Men in the United States.. Archives of sexual behavior. https://doi.org/10.1007/s10508-025-03195-2