Navigating the Health Seas : Experiences of accessing freely available PrEP on the National Health Service

Sidaway, Holly and Bourne, Katy and Rutter, Sarah (2024) Navigating the Health Seas : Experiences of accessing freely available PrEP on the National Health Service. PhD thesis, Lancaster University.

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Abstract

This thesis presents three papers exploring different aspects of Pre-Exposure Prophylaxis (PrEP) in the United Kingdom. This includes a systematic scoping review on knowledge, perceptions, and attitudes towards PrEP; a qualitative study exploring experiences of accessing PrEP on the National Health Service (NHS) and a critical appraisal. Section one reports a systematic scoping review of UK-based literature, which aims to map various aspects of knowledge, perceptions, and attitudes towards PrEP. Forty-seven studies met the requirements for inclusion. Results present a diverse methodological landscape that is rapidly growing in scope. Knowledge and awareness of PrEP were variable across different populations. Underrepresentation in research and media campaigns continues to perpetuate bias towards gay, bisexual, and other men who have sex with men (GBMSM) as being the main proponents of PrEP. Lack of representation and poor awareness of PrEP candidacy impacted the acceptability of PrEP in several groups who experience inequitable PrEP uptake. Self-perceived HIV risk was highlighted as an important factor in PrEP uptake and adherence. Stigma towards PrEP was often associated with moralising views of sex and promiscuity. The empirical section of this project presents a reflexive thematic analysis (RTA) of eight individuals' experiences of accessing freely available PrEP on the National Health Service (NHS). Three main themes were derived from the data. (1) Choosing PrEP: risk analysis at every turn; (2) To be, is to be perceived: the importance of feeling seen, heard and cared for by services; and (3) Added benefits: lifting the weight of risk and freedom to explore pleasure. The final section offers a critical appraisal of the project as a whole including an overview of both papers, bringing together the results and suggesting clinical implications and future research. In keeping with reflexive qualitative methods, positionality, subjectivity and personal reflections will also be discussed.