Table 1:

Overview of Reviewed Studies

Study	Location	Recruitment	Participant Characteristics*	Sexual Orientation	HIV Status	PrEP Status	Study Design	Themes Regarding PrEP Use	Main Findings
1. Gamarel & Golub (2015)	New York, NY; USA	Flyers, outreach, participant referral January 2012 - October 2013	1. N=164 2. 18–61; M=32.49 (SD=10.32) 3. Men=100% 4. White=66; Black=50; Latino=36; Other=12 5. 100% Partnered	100% MSM: Gay=114; Bisexual=38; Other=12	HIV-negative: 100% Partner Status: unknown=17; think positive=124; positive=23	Not on PrEP: 100%	Cross-sectional surveys and in-person interviews (verbal quantitative data collection) (Quantitative)	Perceived HIV risk HIV testing behavior Sexual risk and substance use behavior Condom use motivation PrEP adoption intentions	Intimacy Intimacy interference motivations predicted willingness to adopt PrEP; physical pleasure interference motivations did not. Intimacy interference motivations improved model fit over CAS with outside partners and HIV risk perception with PrEP adoption intentions. Intimacy motivations were not found among single MSM.
2. Collins et al. (2017)	Seattle, WA; USA	Flyers with local PrEP providers July - August 2014	1. N=14 2. 26–66 3. Men=13; Transgender=1 4. White=12; Black=1; Latino=1 5. NR	100% MSM	HIV-negative: 100%	On PrEP: 100%	Semi-structured interviews (Qualitative)	Desire for safer CAS Reduced anxiety and shame Improved sexual satisfaction Stigma of PrEP use within gay community (e.g., promiscuous, irresponsible, risk taker) Stigma of PrEP use in healthcare settings	Intimacy Those in committed serodiscordant relationships more likely to use PrEP to improve intimacy. Sexual Anxiety and Fears PrEP relieved psychological burden of HIV risk and improved self-efficacy and body control. On PrEP, participants reported: less fear, anxiety, panic; more satisfaction, connectivity, sexual liberation, peace of mind.
3. Grace et al. (2018)	Toronto; Canada	PrEP users from Canadian demonstration project November 2014 - June 2016 (PrEP approved in Canada February 2016)	1. N=16 2. 20–60; M=37.6 (SD=NR) 3. Men=15; Transgender=1 4. White=11; Black=1; Asian=1; Indigenous=1; Other=2 5. NR	100% MSM or Gay	HIV-negative: 100%	On PrEP: 100%	Focus groups, In-depth interviews (N=5) (Qualitative)	PrEP use as sexually liberating Equal access to healthy pleasurable sex PrEP-related stigma HIV-related stigma PrEP as revealing structural stigma	Sexual Options "Equality of access to healthy sex that straight people already have" Empowering with HIV-positive partner. Sexual Anxiety and Fears Liberation from fear of CAS. Sex allowed to be enjoyable again. Other Reduced stigma around sex with HIV-positive gay men; no need to ask about HIV status.
4. Hughes et al. (2018)	San Francisco, CA; Miami, FL; USA	Sub-study of multi-site PrEP demonstration project May 2014 - August 2015	1. N=32 (N=15, San Francisco; N=17, Miami) 2. 24–66; M=40 (SD=NR) 3. Men=100% 4. White=13; Black=5; Latino=12; Asian=1; Mixed=1 5. NR	100% MSM	NR	On PrEP: 100%	Semi-structured interviews (Qualitative)	Scheper-Hughes & Locke's (1987) "Three bodies" concept Individual body/selves Social bodies on PrEP Perspectives from the body politic Integration of sexuality and self	Sexual Options PrEP use allowed for sexual liberation and greater self-efficacy. Sexual Anxiety and Fears Influence of PrEP on sexual behaviors may be indirect by reducing anxiety around CAS. Meanings attributed to PrEP use often emotionally charged, bittersweet, reduced fear. Other Sexual decision making as part of social interactions within and outside of relationships. PrEP as a way to prevent HIV understood differently across ages.
5. Malone et al. (2018)	Boston, MA; USA	Urban health center and community-based organizations	1. N=40 (20 couples) 2. 29–45; M=33 (SD=NR) 3. Men=100% 4. White=32; Black=5; Other=3 5. 100% Partnered (M=5.5 years)	100% MSM	HIV-negative: 16 couples HIV-discordant: 4 couples	On PrEP: 52.5% (N=21)	Semi-structured interviews (Qualitative)	Foundation for sexual agreements and improving communication Emotional monogamy PrEP and sexual agreements PrEP and risk mitigation of consequences of partner's risk behaviors	Sexual Options PrEP to reduce HIV risk individually and for their committed relationship. PrEP helping relationships to be sexually open/lower risk of sexual agreements. Anxiety and Fears PrEP helped to restore trust, confidence, and safety in relationships. Using PrEP for reduced anxiety/peace of mind. Other Using PrEP highlighted risk awareness and did not result in risk compensation. Prioritizing HIV-prevention.
6. Gamarel & Golub (2019)	New York, NY; USA	Flyers, outreach, participant referral, SPARK PrEP demonstration project April 2013 - October 2013	[Study 1/Study 2] 1. N=51/145 2. 19–61; M=32.14 (SD=NR)/21–63; M=34.30 (SD=NR) 3. Men=41/145 4. White=20/77; Black=18/16 5. 100% Partnered	100% Gay or Bisexual	HIV-negative: 100%	Not on PrEP: 100%/66.9% (N=97)	Both Studies: Computer-assisted interview surveys (Quantitative)	Study 1: Closeness discrepancy (IOS) Condom intimacy interference Perceived HIV risk Sexual risk behavior PrEP adoption intentions Study 2: Relationship quality Sexual satisfaction PrEP uptake	Intimacy Majority in both samples desired more closeness in their relationships. Study 1: Closeness discrepancy scores and intimacy interference positively associated with PrEP intentions. Study 2: Desiring more closeness predicted PrEP uptake. Study 2: Actual closeness and intimacy interference predicted PrEP uptake, but no interaction (separate motives). Other Study 2: Open sexual agreements not inherently risky.
7. Mabire et al. (2019)	France	Men from ANRS-IPERGAY PrEP trial 2014	1. N=45 2. 20–67; M=35 (SD=NR) 3. Men=100% 4. NR 5. Partnered=17	100% MSM: Gay=40; Undefined=5	HIV-negative: 100%	On PrEP: 100%	Semi-structured interviews (Qualitative)	Relationship with condoms Intimacy and pleasure Achieving better sexual quality of life	Intimacy PrEP allows greater physical and psychological intimacy. Ending condom use a sign of intimacy. Sexual Options PrEP allows choice of sexual position. Physical Closeness Condoms as reducing sexual pleasure, in terms of activity and putting them on (reduced "fear of loss of performance"). Sexual "fulfilment as opposed to frustration". Other Sexual agency and control over risk.
8. Nakku-Joloba et al. (2019)	Uganda	Partners Demonstration Project (PrEP)	1. N=186 (93 couples) 2. 25–37 3. Men=143; Women=43 4. Black=100% 5. 100% Partnered	MSM, Heterosexual (number NR)	HIV-serodiscordant couples: 100%	On PrEP: 79.5% (N=148)	Interviews (274 total; 148 couples; 126 individuals) (Qualitative)	PrEP alleviated threat to relationships PrEP as a way to stop using condoms PrEP allows serodiscordant relationships to continue	Intimacy/Physical Closeness PrEP to make it "safe" for "live sex" to increase intimacy and closeness. Reluctance to use PrEP and condoms together, as undermining intimacy. Sexual Options/Sexual Anxiety and Fears PrEP reduced fear and brought back hope in making future plans for family. Other PrEP increased sexual desire. PrEP restores hope in relationships.
9. Whitfield et al. (2019)	National Cohort; USA	Cohort of Gay Black men from the "One Thousand Strong" longitudinal study	1. N=137 2. 18–45+; M=35.98 (SD=NR) 3. Men=100% 4. White=96; Black=15; Latino=15; Other/Multiracial=11 5. Partnered=63	100% MSM, Gay, Bisexual	HIV-negative: 100%	Baseline: 0% (entire sample never used PrEP) Final Follow-up: Currently on PrEP: 88.3%	Survey data (Quantitative)	Multidimensional sexual self-concept Measured sexual satisfaction, esteem, and anxiety PrEP use	Physical Closeness CAS with casual partners and being in a relationship predicted sexual satisfaction. Sexual Anxiety and Fears PrEP use predicted lower sexual anxiety, greater for older age participants. Other PrEP use did not predict sexual esteem or sexual satisfaction (Note: sexual satisfaction scale did not directly assess physical pleasure).
10. da Silva-Brandeo & Zollner Ianni (2020)	Facebook posts; primarily USA	PrEP users in Facebook discussion group	1. NR 2. NR 3. NR, mainly men 4. NR 5. NR	100% MSM, Gay, Bisexual	NR	On PrEP: 100%	Analysis of Facebook posts (Qualitative)	Experience of individuals on PrEP Production of sexual desires and/or pleasures User individuation and identity expression Social context of PrEP	Sexual Options CAS is a possibility; change in forms of pleasure; bareback sex can be responsible, not libertarian. Sexual choices not framed by risk. Physical Closeness Allows experience of natural skin on skin sex, as opposed to "unnatural" (some caution with the term as inferring deviant sex). Other Potential for greater positivity towards sex: sex equaling pleasure instead of risk.
11. Gamarel & Golub (2020)**	New York, NY; USA	Community-based service organizations, support groups, drug treatment centers, SPARK PrEP demonstration project January 2014 - October 2015	1. N=145 2. 21–63; M=34.30 (SD=NR) 3. Men=100% 4. White=77; Black=16; Latino=29; Other=23 5. Partnered=79 (at follow-up)	100% MSM: Gay=110; Bisexual=19; Other=15	HIV-negative: 100% Partner Status: HIV-negative: 84 HIV-positive: 48 Unknown: 13	On PrEP: 66.9% (N=97)	Open-ended survey questions, survey data (Mixed)	PrEP adoption Perceptions of goal congruence Relationship quality Sexual satisfaction Risk perception Sexual behavior Sexual goals and priorities Relation focused vs. self-focused	Intimacy Intimacy goals to be connected to partner more relationship focused; intimacy goals included sexual freedom in relationships. Sexual Options Satisfaction goals more self-focused: "to explore all types of pleasure". Other Higher goal congruence, HIV-positive status of partner, higher sexual satisfaction predicted PrEP adoption. Prevention goals of sexual health more self-focused, some for protection of partner.
12. Harrington et al. (2020)	London; United Kingdom	Social media advertisement on a United-Kingdom-based non-profit community group	1. N=13 2. 26–56; M=37 (SD=NR) 3. Men=100% 4. White=9; Black=2; Indian=1; Other=1 5. NR	100% MSM	HIV-negative: 100%	On PrEP: 100%	Semi-structured interviews (Qualitative)	PrEP and condom use Lessened anxiety around HIV Increased intimacy and pleasure Sense of sexual liberation Ease of using PrEP Activism by early adopters of PrEP	Sexual Options Reduction of risk of CAS; less emphasis on condom use; condom use at request of non-PrEP partner. PrEP increased sexual agency, more freedom to explore sexuality, less inhibited. Sexual Anxiety and Fears Sexual encounters more pleasurable with less anxiety, more intimacy and physical pleasure.
13. Philpot et al. (2020)	Australia	Online advertisements on social media platforms, popular gay and bisexual dating apps 2017 (just prior to PrEP approval in Australia)	1. N=1404 2. 16.5–50+ 3. Men=100% 4. NR 5. NR	100% MSM	HIV-negative or untested: 100%	Mixed (number NR)	Survey/online longitudinal study, free text responses (Mixed)	Positive social impact Overcoming fear and anxiety Enhancing sexual pleasure and opportunity Negative social impact	Sexual Options/Physical Closeness More "natural" sex, more sexual pleasure, more sexual options. Sexual Anxiety and Fears Concern for increase in CAS; false sense of security around STIs. Other Redefining safe sex and potential to reduce HIV stigma. Lessening sexual inhibitions. Potential impacts on gay community to be seen as irresponsible or lazy; encouraged promiscuity. Pressure to engage in socially undesirable sexual behavior.
14. Quinn et al. (2020)	Milwaukee, WI; Minneapolis, MN; Detroit, MI; Kansas City, MO; USA	Community organizations in study cities (e.g., flyers in clinics, HIV testing centers, LGBT community centers, local hangout locations), targeted Facebook ads 2018	1. N=36 2. 20–30; M=25.9 (SD=NR) 3. Men=100% 4. Black=36 5. Partnered=15	100% MSM: Gay=25; Bisexual=5; Other=6	HIV-negative: 100%	Current PrEP user: 75% (N=27) Former PrEP user: 25% (N=9)	Focus groups (Qualitative)	Reduced sexual and HIV anxiety Increased sexual freedom Facilitated sexual relationships with PLWH	Sexual Options Freedom to consider new sexual positions, less risk when bottoming. Sexual Anxiety and Fears PrEP reduced anxiety around having sex, which existed even with condoms. PrEP safety net includes increased HIV testing, can explore sexuality. Positive sero-discordant relationships, reduced HIV stigma, increased comfort. Other CAS viewed as "sexier". Increased control over sexual risk, not having to rely on partner. PrEP as showing love for HIV-positive partners.
15. Reyniers et al. (2020)	Belgium	PrEP demonstration project October 2015 - May 2018	Surveys/ Interviews 1. N=200/22 2. M=38/37 3. Men=197; Transgender Women=3/Men=22 4. White=178/19; Arabic/Latino=22/3 5. Partnered=90/4	100% MSM: Gay=144/17	HIV-negative: 100%	On PrEP: 100%	Surveys, interviews (Mixed)	Evaluation of sex life Healthy sexuality Sexual risk behavior Feeling better protected against HIV Improved sexual health Reduced condom use More sex and more anal sex Experimentation with new sexual behaviors	Sexual Options Ability to seek out more enjoyable sex. More sex, more anal sex, sexual experimentation. Increased group sex in qualitative but not quantitative data. Physical Closeness PrEP reduced psychological barriers to having sex (staying erect). Sexual Anxiety and Fears Better sex due to less anxiety Other No significant change in mean sexual satisfaction.
16. Skinta et al. (2020)	San Francisco, CA; USA	Flyers, billboards in historically gay neighborhood, participant-driven recruitment February 2016	1. N=6 2. Mid 20's-late 30's 3. Men=100% 4. White=3; Latino=3 5. NR	100% MSM/Gay	HIV-positive: 100%	Not on PrEP: 100%	Semi-structured interviews (Qualitative)	Desire for intimate connection Remembered experiences of stigma Men who do not take PrEP are suspect Awareness of the changing meaning of HIV	Intimacy Greater experience of sexual intimacy. PrEP as a sign of commitment to a partner. Sexual Options More sexual openness. PrEP requirement for some when using dating applications. Easier for HIV-positive men to find partners. Other PrEP allowed greater agency over self-protection.

^*1. N=# of participants; 2. Age range, Mean (standard deviation) if reported; 3. Gender; 4. Race/ethnicity; 5. Partnered status.

^**Same study sample as Gamarel & Golub (2019) Study 2

NR: Not Reported; MSM: men who have sex with men; IOS: inclusion of self in others; CAS: condomless anal sex; PLWH: people living with HIV