Grant Robert M, Koester Kimberly A
aGladstone Institutes bUniversity of California cSan Francisco AIDS Foundation, San Francisco, California, USA.
Curr Opin HIV AIDS. 2016 Jan;11(1):3-9. doi: 10.1097/COH.0000000000000216.
As demand for preexposure prophylaxis (PrEP) increases, we are learning more about what people want from sex and PrEP.
PrEP demand has reached a tipping point in the USA and is increasing rapidly. Although the primary benefit of PrEP use is biological, to reduce risk of HIV infection, PrEP users often express an alternative set of social and emotional benefits that are provided by PrEP. These collateral benefits of PrEP have salience, affect, and are experienced in the present, which are compelling drivers of human behavior. PrEP use has been associated with feeling safe during sex, usually in contrast to ruminations related to fear of HIV or intimate partner violence or control. PrEP can create empowerment, or agency, defined as the capacity and autonomy to act on one's own behalf, because it provides control over one's vulnerability to HIV and relief to women and men who may otherwise worry about whether their partners will use a condom, take antiretroviral therapy, or disclose their HIV status accurately. Planning for sexual and social goals in calm moments is also empowering. These highly desired collateral benefits of PrEP could be undermined, or eliminated, if PrEP is implemented in ways that are coercive or that foment fear of sexual risk compensation, drug resistance, toxicity, or moral judgment.
Current PrEP implementation provides direct and indirect benefits that are highly desired.
随着暴露前预防（PrEP）需求的增加，我们对人们在性和PrEP方面的期望有了更多了解。
在美国，PrEP需求已达到临界点且正在迅速增长。虽然使用PrEP的主要益处是生物学上的，即降低感染HIV的风险，但PrEP使用者常常表达出PrEP带来的一系列其他社会和情感益处。PrEP的这些附带益处具有显著性、影响力，且是当下就能体验到的，是人类行为的有力驱动因素。使用PrEP与性行为时感到安全有关，这通常与担心感染HIV、亲密伴侣暴力或控制等反复思考形成对比。PrEP可以带来赋权，即代表自己行动的能力和自主性，因为它能让人控制自身感染HIV的易感性，并让那些原本可能担心伴侣是否会使用避孕套、接受抗逆转录病毒治疗或准确披露其HIV感染状况的男女感到宽慰。在平静时刻规划性和社会目标也能带来赋权。如果以强制方式实施PrEP，或者引发对性风险补偿、耐药性、毒性或道德评判的恐惧，PrEP这些备受期待的附带益处可能会受到损害或消除。
当前PrEP的实施带来了人们高度期望的直接和间接益处。
