Addressing Stigma is Essential for Increasing PrEP Uptake and Adherence in HIV Prevention Efforts

Addressing stigma associated with pre-exposure prophylaxis (PrEP) is crucial for improving its uptake and adherence among eligible populations, according to study results published in Sexes.

Despite significant advancements in HIV treatment and prevention, the ongoing HIV pandemic continues to affect millions. The Centers for Disease Control and Prevention (CDC) reported over 1.2 million individuals living with HIV in the US as of 2019, with approximately 34 800 new diagnoses that year. This decline in new cases has spurred initiatives like the Ending the HIV Epidemic (EHE) Plan, which aims to reduce new infections through strategies including the promotion of PrEP as a preventive measure.

However, the uptake of PrEP has been slower than anticipated, largely due to perceived stigma (PS) surrounding its use. Perceived stigma is defined as the fear of discrimination that can lead individuals to alter their behavior to avoid social consequences. Research shows that stigma surrounding PrEP often arises from misconceptions about users' sexual behavior and perceived HIV risk. This stigma disproportionately affects marginalized groups, including sexual minority men, transgender individuals, and racial minorities, exacerbating existing health disparities.

“Understanding such perception and its correlates can inform our strategies to reduce PS among PrEP-eligible individuals and vulnerable populations,” wrote Shahin Davoudpour, Feinberg School of Medicine, Northwestern University in Chicago, IL, and coauthors.

Key findings revealed that younger individuals were more likely to associate PrEP use with promiscuity (adjusted odds ratio [aOR] = 0.97; 95% CI: 0.95, 0.995). Educational attainment also played a role, with those holding a doctoral degree more likely to express PS related to both promiscuity (aOR = 3.46; 95% CI: 1.76, 6.80) and HIV-positive status (aOR = 1.86; 95% CI: 1.05, 3.29).

The study found racial and ethnic differences, with Latinx participants less likely to associate PrEP with promiscuity (aOR = 0.74; 95% CI: 0.60, 0.93) and HIV-positive status (aOR = 0.81; 95% CI: 0.67, 0.99) compared with White participants. Additionally, Black participants were less likely to associate PrEP use with promiscuity (aOR = 0.76; 95% CI: 0.57, 0.998).

Knowledge of PrEP was associated with lower PS regarding HIV-positive status (aOR = 0.85; 95% CI: 0.73, 0.99), but did not significantly affect views on promiscuity. Individuals with higher perceived HIV risk were more likely to express stigma related to both promiscuity (aOR = 1.42; 95% CI: 1.27, 1.59) and HIV-positive status (aOR = 1.29; 95% CI: 1.17, 1.43).

“Perhaps, instead of highlighting the benefits of PrEP repeatedly, public health messaging can shift its focus to decreasing the perception of PrEP stigma among those vulnerable to HIV,” concluded the study authors. “This can be achieved via sex-positive messaging with the goal of disassociating PrEP from promiscuity while emphasizing its use among those vulnerable to HIV,” they added.

Reference

Davoudpour S, Phillips GL II, Serrano PA, French AL, Hosek SG. Factors associated with perception of stigma attached to PrEP: evidence from the Keeping It LITE Study. Sexes. 2024;5(3):300-316. doi:10.3390/sexes5030023.