Psychological issues and PrEP in private practice

When pre-exposure prophylaxis (PrEP) was newly marketed towards and available to urban men whop have sex with men, a cultural phenomenon with deeply personal psychological implications began. The widespread availability of PrEP resurrected long-dormant conflicts in patients, therapists, and primary care providers about sexual acts between men; about sexual agency and autonomy'' and re-traumatization from similar conflicts believed to have been worked through during earlier decades of the HIV/AIDS epidemic. Patients often are not aware of the depth;of psychological implications. If a therapist is unaware of the momentous cultural event, he or she may over-interpret, missing or distorting important assessments of risk, danger and safety. A therapist's over-identification with the event may lead to under appreciation and exploration the depths and mu determination of intra-psychic meaning and symbolism including the patient's conscious and unconscious use of the cultural phenomenon to express myriad intra-psychic and inter-personal con flicts In this paper I describe five HIV-negative patients' reactions to PrEP as it was becoming widely marketed and debated in New York City.