Sexual satisfaction and adherence to daily oral pre-exposure prophylaxis: An analysis of the Ontario PrEP Cohort Study

HIV pre-exposure prophylaxis (PrEP) can be associated with increased sexual satisfaction. We examined associations between aspects of sexual satisfaction and adherence to daily oral PrEP among participants in the Ontario PrEP Cohort Study (ON-PrEP). ON-PrEP was a prospective cohort of Ontario PrEP users with biannual study visits for up to two years. Participants rated aspects of their sexual satisfaction on a scale from 1–5 (not satisfied-extremely satisfied) using three items from the New Sexual Satisfaction Scale. PrEP adherence was measured as perfect versus less-than-perfect daily adherence in the last four days. We used multivariable random-intercept binomial mixed effects models to estimate how the odds of reporting perfect adherence varied per unit increase in each of the three time-updated sexual satisfaction items, stratified by how highly participants ranked sexual pleasure and intimacy among their motivations for taking PrEP. Of 618 participants taking daily oral PrEP (87.1% gay, 66.7% White) with median age 36 years (Q1 = 30, Q3 = 45), average ratings of the three sexual satisfaction aspects were high and stable over time. Higher ratings of “letting go/surrendering to sexual pleasure” were associated with 1.52 (95% CI = 1.03–2.25) greater odds of perfect daily PrEP adherence among those rating sexual pleasure or intimacy among their top two reasons for taking PrEP. Sexual satisfaction was high in this cohort and “letting go/surrendering to sexual pleasure” was associated with greater daily PrEP adherence among those in whom sexual pleasure/intimacy were top motivators for PrEP use. Leveraging this in health messaging may improve PrEP adherence.