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Why I Quit Pre-Exposure Prophylaxis (PrEP)? A Mixed-Method Study Exploring Reasons for PrEP Discontinuation and Potential Re-initiation Among Gay and Bisexual Men

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Abstract

Literature concerning pre-exposure prophylaxis (PrEP) among gay and bisexual identifying men (GBM) has explored facilitators and barriers to uptake and adherence. Far less reported are the reasons why GBM discontinue PrEP use. A national sample of 1071 GBM completed surveys about PrEP use and discontinuation. Participants who were still taking PrEP the 24-month follow up were compared to those that had stopped. Eighteen percent (n = 31) of GBM who reported ever using PrEP discontinued use. Younger (AOR = 0.96; 95% CI 0.92–1.00), and unemployed (AOR = 4.58; 95% CI 1.43–14.70) GBM were more likely to discontinue PrEP than their counterparts. Those that discontinued provided details on why via a free response question. The most common reasons for discontinuation were lower perceived HIV risk (50%) and cost/insurance (30%). Reasons for potential re-initiation included higher-risk sexual activities and changes to structural related barriers. More research is needed to inform interventions on how GBM can continue taking PrEP during changes to employment that effect insurance coverage and cost.

Resumen

La literatura sobre la Profilaxis Pre-Exposición (PrEP) entre hombres que se auto identifican como gay y bisexuales (HGB) ha explorado facilitadores y barreras al uso y la adherencia a la PrEP. Mucho menos reportadas son las razones por las cuales HGB discontinúan el uso de la PrEP. Una muestra nacional de 1071 HGB completó encuestas sobre el uso y la discontinuación de la PrEP. Participantes que todavía estaban tomando PrEP durante su seguimiento a los 24 meses fueron comparados con aquellos que habían dejado de usarla. HGB más jóvenes (AOR = 0.96; 95% C.I. = 0.92-1.00) y desempleados (AOR = 4.58; 95% C.I. = 1.43-14.70) tuvieron una probabilidad más alta de discontinuar la PrEP que sus homólogos. Aquellos que la discontinuaron proveyeron detalles sobre el por qué a través de un cuestionario de repuesta libre. Las razones más comúnmente citada para la discontinuación fueron: bajo riesgo percibido de contraer VIH (50%) y costo/seguro de salud (30%). Razones para potencialmente reiniciarla incluyeron actividades sexuales de más alto riesgo y cambios en las barreras estructurales relacionadas. Mas investigación es necesaria para informar intervenciones sobre cómo los HGB pueden continuar tomando PrEP durante periodos de cambio en el empleo que afectan la cobertura de salud y su costo.

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Acknowledgements

One Thousand Strong study was funded by a research Grant from the National Institute on Drug Abuse (R01-DA036466; Jeffrey T. Parsons & Christian Grov, MPIs). H. Jonathon Rendina was supported by a Career Development Award from the National Institute on Drug Abuse (K01-DA039030; H. Jonathon Rendina, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to acknowledge the contributions of the other members of the One Thousand Strong Study Team (Ana Ventuneac, Demetria Cain, Mark Pawson, Ruben Jimenez, Chloe Mirzayi, Brett Millar, Raymond Moody, and Steve John) and other staff from the Center for HIV/AIDS Educational Studies and Training (Chris Hietikko, Andrew Cortopassi, Brian Salfas, Doug Keeler, Chris Murphy, Carlos Ponton, and Paula Bertone). We would also like to thank the staff at Community Marketing Inc. (David Paisley, Heather Torch, and Thomas Roth). Finally, we thank Jeffrey Schulden at NIDA, the anonymous reviewers of this manuscript, and all of our participants in the One Thousand Strong study.

Funding

Funding support was provided by the National Institute of Drug Abuse (R01-DA036466; PIs: Parsons & Grov). H. Jonathon Rendina was supported, in part, by a National Institute on Drug Abuse Career Development Award (K01-DA039030).

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Authors and Affiliations

  1. Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), 695 Park Ave., New York, NY, 10065, USA

    Thomas H. F. Whitfield, Steven A. John, H. Jonathon Rendina & Jeffrey T. Parsons

  2. Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA

    Thomas H. F. Whitfield, H. Jonathon Rendina & Jeffrey T. Parsons

  3. Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA

    H. Jonathon Rendina & Jeffrey T. Parsons

  4. CUNY Graduate School of Public Health and Health Policy, New York, NY, USA

    Christian Grov

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  1. Thomas H. F. Whitfield
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Correspondence to Jeffrey T. Parsons.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Whitfield, T.H.F., John, S.A., Rendina, H.J. et al. Why I Quit Pre-Exposure Prophylaxis (PrEP)? A Mixed-Method Study Exploring Reasons for PrEP Discontinuation and Potential Re-initiation Among Gay and Bisexual Men. AIDS Behav 22, 3566–3575 (2018). https://doi.org/10.1007/s10461-018-2045-1

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