Alarming:  Young MSM Discontinuing PrEP

     Breaking—and alarming–news:  a third of young MSM (men who have sex with men) who take PrEP (pre-exposure prophylaxis) discontinue it within six months.  This is according to U.S. investigators in AIDS and Behavior, a peer-reviewed medical journal established in 1997 that covers aspects of HIV/AIDS research.  Common reasons for this discontinuation included being unable to get a doctor’s appointment and insurance coverage problems.

     The investigators write, “’The two most common factors for discontinuation of use…are systemic barriers, indicating that more needs to be done to increase PrEP for those who are at high HIV risk.  One potential solution may be to enable service providers, such as local health departments, to incorporate proactive services for high-risk HIV-negative individuals’.”

     What’s really disturbing?  That none of the men who discontinued PrEP reported 100% condom use, and over 40% said they never used condoms after stopping.  

     PrEP is a highly-effective method of HIV prevention.   And if taken consistently, it can reduce HIV infection risk by over 90%. 

     Since little is known about why men discontinue PrEP, investigators crafted a study analyzing rates and reasons for PrEP discontinuation and sexual behavior after stopping the drug.  The study involved young sexually active MSM PrEP users in Chicago.

     Study participants were between 16-29 years of age.  The men were asked at follow-up appointments if they’d taken or discontinued PrEP in the previous six months.  Those who reported stopping PrEP were asked why.  A subset was asked about condom use after discontinuing PrEP.

     The study occurred between 2015 and 2017.  During that timeframe, 197 participants reported using PrEP in the previous six months.  A third (65) stated that they had stopped using the drug by the time of their follow-up interviews.  Black and Hispanic men were significantly more likely to report discontinuation than white men. 

     “’These findings are particularly concerning given that Black and Hispanic MSM are also those at greatest risk of HIV’,” the researchers stated.  “’These emerging racial disparities in discontinuation may be due to structural differences between populations, for example, differences in access to healthcare facilities or access to or cost of insurance’.”

     A total of 29 persons were asked about discussions they had had with their medical practitioners concerning PrEP usage.  Most (79%) hadn’t spoken to their physician before ending treatment.

     Thirty-five men were asked about their sexual behavior after discontinuing treatment.  More than half (58%) said that they continued to engage in anal sex, with 41% reporting that they never used condoms, 35% stating that they used condoms less than 50% of the time and 24% reporting that they used condoms most of the time.  None said they always used condoms. 

     What were the common reasons for discontinuing PrEP?  These included:

  • being unable to get a doctor’s appointment (22%);
  • insurance problems (20%);
  • individuals no longer perceiving themselves as being at risk for HIV (19%);
  • side effect concerns (9%);
  • adherence (8%); and
  • stigma (6 %).

     The authors conclude, “’We observed several important factors which must be considered and addressed if PrEP usage is to continue to rise.” They then added, “’Further research must be conducted to look beyond medication adherence and develop a better understanding about which other prevention strategies are used following purposeful PrEP discontinuation’.”

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