Brief Report: Intersectional Stigma Associations With Long-Acting Injectable PrEP Willingness and Preference Among Cisgender Gay, Bisexual, and Other Men Who Have Sex With Men: A Brief Quantitative Report.

Abstract

Background: Gay, bisexual, and other men who have sex with men (GBMSM) in the United States are disproportionately affected by the HIV epidemic. Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) represents a novel HIV prevention strategy. However, stigma remains a barrier to HIV-related prevention and care. We investigated the role of intersectional stigma in LAI-PrEP preferences among past-year PrEP-naive, HIV-negative US cisgender GBMSM.

Methods: The 2022 American Men's Internet Survey enrolled cisgender GBMSM online between October 2022 and October 2023. Using bivariate and multivariable adjusted Poisson regression with robust variance and a modified Intersectional Discrimination Index to examine associations between several forms of stigma-anticipated, day-to-day, social systems exclusion, and violence and harassment-and LAI-PrEP willingness and preference.

Results: Among participants (N = 1196), 705 (59.0%) were willing to use any PrEP modality and 393 (32.9%) were willing to use LAI-PrEP, among whom 211 (29.9%) reported a preference for LAI-PrEP. On average, participants experienced 1.8 of 7 anticipated discrimination items, 3.9 of 7 day-to-day discrimination items, 0.2 of 3 social systems exclusion items, and 0.9 of 4 violence/harassment items. Willingness to use LAI-PrEP was associated with anticipated stigma (adjusted prevalence ratio [aPR] = 1.06; 95% confidence interval [CI] = 1.02 to 1.10; P < 0.01). Preference for LAI-PrEP was associated with anticipated stigma (aPR = 1.06; 95% CI = 1.00 to 1.12; P = 0.04), day-to-day (aPR = 1.09; 95% CI = 1.02 to 1.15; P = 0.01) stigma, and violence/harassment (aPR = 1.09; 95% CI = 1.01 to 1.18; p-0.03).

Conclusions: Given disproportionate HIV burden among GBMSM, a range of HIV PrEP modality options combined with efforts to address intersectional anticipated and enacted stigma among GBMSM is critical to ensure PrEP access, uptake, and adherence.