Abstract
This study explored familiarity with, attitudes toward, uptake and discontinuation of PrEP (Pre-exposure prophylaxis) among a national probability sample of gay and bisexual men. PrEP is one of the most effective biomedical HIV prevention strategies; however, use among gay and bisexual men remains low within the United States. This study used a national probability sample of gay and bisexual men from three age cohorts of men (18–25, 34–41, and 52–59 years at wave 1) who completed three annual surveys between March 2016 and March 2018 (N at wave 1 = 624). Recruitment occurred through a Gallup dual-frame sampling procedure; results for this study came from eligible individuals who consented to be part of the self-administered online or mailed survey questionnaire. We used descriptive data with sampling weights to understand trends in PrEP familiarity, PrEP attitudes and PrEP use across all three time points. Next, PrEP uptake and discontinuation were assessed among men completing all three surveys and who remained eligible for PrEP at all three time points (N = 181). PrEP familiarity increased considerably between 2016 and 2018 among those eligible for PrEP (from 59.8% from wave 1 to 92.0% at wave 3). Favorable attitudes toward PrEP increased more modestly (from 68.3% at wave 1 to 72.7% at wave 3). While PrEP use increased by 90% between the two time points (from 4.1% in 2016 to 7.8% in 2018), this represented a small percentage of overall uptake among eligible participants across time (6.6%). Among respondents who reported PrEP use at wave 1 or wave 2, 33.3% subsequently discontinued PrEP use at a later wave. Findings indicate modest increases in PrEP use between 2016 and 2018 in a national probability sample of sexually-active gay and bisexual men. PrEP discontinuation was high and suggests the need for further research into gay and bisexual men’s PrEP discontinuation and persistence.
Highlights
Pre-exposure prophylaxis (PrEP) is an established biomedical HIV prevention strategy to reduce incident infections among gay, bisexual and other men who have sex with men (GBMSM)
The majority of PrEP eligible participants identified as gay and the majority identified as white
Our data demonstrate PrEP use increased by 90% from wave 1 to wave 3, indicating greater coverage over the course of three years, there is substantial room for improvement
Summary
Pre-exposure prophylaxis (PrEP) is an established biomedical HIV prevention strategy to reduce incident infections among gay, bisexual and other men who have sex with men (GBMSM). PrEP involves daily use of one of two HIV medications, Truvada or Descovy, to prevent HIV acquisition [1,2], and is a principal strategy of the United States’ “Ending the HIV Epidemic: A Plan for America” [3]. Since 2012, when daily dosing of Truvada for PrEP was first approved by the Food and Drug Administration, familiarity with this prevention strategy has increased considerably, with estimates indicating an increase in familiarity from 47.4% in 2013 to 80.6% in 2017 among a national non-probability sample of PrEP-eligible MSM in the U.S [4]. Attitudes toward PrEP among GBMSM have been mixed since Truvada was first approved in 2012 [6]. A national probability sample of sexually active gay and bisexual men estimated over twothirds (68.4%) of those familiar with PrEP held favorable attitudes toward the prevention strategy in 2016 [11]. No national data derived from probability samples on PrEP attitudes have been published since that time
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