Taking control

Men taking PrEP show decrease in ‘sexual compulsivity’ and drug use

A man holds a PrEP Truvada tablet
Posed by model (Photo: Shutterstock)

A study from the Netherlands says gay and bi men taking PrEP show a reduction in the use of certain other drugs and in “sexual compulsivity.”

“Sexual compulsivity” is sexual behavior that might be deemed problematic.

The participants filled in questionnaires with questions such as: “My sexual thoughts and behaviors are causing problems in my life,” and “I sometimes fail to meet my commitments and responsibilities because of my sexual behaviors.” Anyone scoring at least 24 out of 40 in the questionnaire was said to exhibit a high degree of sexual compulsivity.

Related: Slut shaming of men on PrEP is still happening at a ridiculous rate, study finds

The study appeared last week in The Lancet. The authors said they set out to look at the mental health of gay and bi men taking PrEP. They wanted to see whether taking the medication – which stops you from acquiring HIV – impacted alcohol and drug use, alongside tracking the mental health of participants.

The AMsterdam PrEP study looked at over 340 individuals over three years. Subjects attended the biggest STI clinic in Amsterdam. In the three months leading up to the study, “participants reported a median of 15 sexual partners” each, and 37% used five or more types of drugs.

Many studies have found that LGBTQ people are more likely to experience mental health problems than their straight peers. We’re also more likely to drink heavily or take drugs. Because of this, it’s not surprising that a higher number of those taking PrEP in the study reported experiencing issues such as anxiety and depression than the general Dutch population.

The study’s key findings included:

  • Those reporting sexual compulsivity fell from 23% to 10% over the three years.
  • Drug use decreased by 38% to 31%. This was chiefly a fall in the use of ecstasy (MDMA) and poppers. No significant fall was seen in the use of other drugs (GHB, cocaine, etc).
  • There was no significant fall in those reporting problematic drinking.
  • There was no significant change in the numbers reporting anxiety or depression. However, there was a significant fall in anxiety related to acquiring HIV.
  • The men in the study were less likely to seek help for their reported mental health problems (only 18% said they sought help) compared to the wider Dutch population (34% of those with mental health problems say they’ve spoken to a medical practitioner about it).

In their conclusion, the authors say the “decrease in drug use disorder and sexual compulsivity was unexpected.”

Speculating on the reasons behind the results, they say that the drop in anxiety over acquiring HIV could make some people less reliant on drugs to combat their sexual inhibition.

They also point to the fact that those taking PrEP had to go for a three-monthly STI check-up. This means they’re more likely to receive motivational counseling about their sexual behavior, which could explain the drop in sexual compulsivity. The regular check-ups might make them think more about their health choices.

However, the authors say more studies are needed, as it’s “unclear why the proportion of those with drug-use disorder was declining while that of anxiety or depression did not change during PrEP use.”

They also say more can be done to address the level of anxiety and depression among people seeking PrEP, and “PrEP services offer a unique opportunity to integrate mental health care.”

Related: Many guys on PrEP are not getting regularly tested for STIs