Generational perspectives on PrEP, prevention, and sexual practices in MSM (ANRS-PREVENIR cohort)

This study explored perceptions of sexual norms and practices related to HIV prevention and PrEP use among three generations of men who have sex with men (MSM) in the ANRS-PREVENIR cohort in France in 2022. Using a qualitative approach with three focus groups, we identified key themes: societal transformations, evolving sexual norms, and changing attitudes toward PrEP. Participants (29-63 years) belonged to three distinct generational groups: those who began their sexual life before 1981 (pre-HIV era), between 1981 and 1995 (HIV era, pre-ARV), and after 1995 (post-ARV era). Results reveal changes regarding sexual norms and practices, including reduced condom use, PrEP's role as a turning point in HIV prevention, offering freedom from the constraints previously imposed by the epidemic, and a perceived reduction in PrEP-related stigma. These changes were more pronounced in the two older generations who experienced the most the societal transformations. PrEP seems to gradually replacing condom use as the main HIV prevention tool, becoming central to MSM's individual harm reduction strategies. Its widespread use also appears to facilitate access to a larger number of new sexual partners. While PrEP-related stigmatization has decreased, it persists, negatively affecting prevention strategies. This underscores the need for inclusive, adapted PrEP promotion.