Study: PrEP Use Rising, Still Low Among Gay, Bisexual Men

A new study from the University of California at Los Angeles (UCLA) has identified some curious – and not entirely reassuring – trends around the use of pre-exposure prophylaxis, or PrEP, a regimen of medication that is highly effective at preventing HIV transmission when used properly by HIV-negative people.

One form of PrEP is Truvada, a pill that is recommended to be taken once daily. Another is Descovy, which is also taken once per day. An injectable medication promises to provide the same protection, or even better, with doses administered every two months.

Truvada was approved in 2012, and there were stigma and pushback at the time. "Stigma surrounding the use of PrEP, concerns regarding long-term side effects, conflicting messages from AIDS service providers, and lawsuits and social media misinformation campaigns have possibly created confusion about PrEP's benefits," the study noted.

Even so, the new study found that familiarity with PrEP was increasing, as was its use, but while there was a 90% increase in the use of PrEP over two years (2016-2018), as well as less stigma, one-third of men who had started the regimen gave it up. Moreover, in terms of real numbers, that 90% increase did not make for a majority among gay and bisexual men, with less than 8% of the eligible population availing themselves of the medication in 2018.

The study drew data from three waves of annual surveys completed by study participants over several years. Participants were deemed "eligible if they (a) identified as gay, lesbian, bisexual, queer, or same-gender-loving, (b) were not transgender, (c) were Black, Latino, or White race/ethnicity, (d) were ages 18–25, 34–41, or 52–59 years old, (e) completed a sixth-grade education, and (f) answered the phone interview in English," the study explained.

"Transgender respondents were invited to participate in a concurrent study focused on the experiences of transgender people," the report indicated.

The study also highlighted race disparities, with Black and Latinx men using PrEP at lower rates than whites. (The study acknowledged not having investigated attitudes and use among Asian Americans, Native Americans, and Alaskan Natives.) Economic factors also played a part. (One controversial aspect of Truvada is charges of price gouging by pharmaceuticals company Gilead).

Other factors included "lack of access to a provider, poor patient-provider communication, concerns about side effects, and stigma."

"Structural challenges must be addressed through policy change and scholars have suggested nationwide Medicaid expansion and generic formulations of PrEP to address cost concerns," the study added.

One area in which the study acknowledged an in-built deficiency was in understanding PrEP use in the context of specific sexual practices. "Because these data were part of a larger study to understand a variety of health and well-being indicators among LGB people, no sexual behavior data or data on PrEP dosing strategies was collected," the study said. "This prevents us from understanding PrEP uptake and discontinuation in context of behavioral risk."