New research explores the reasons men stop taking PrEP

New research published in AIDS and Behaviour reveals that 18% of study participants who started using PrEP stopped using the ‘game changing’ HIV prevention pill at some point during the two-year study period. The research provides the first qualitative insight into what drives this drop off.

Over 1,000 gay and bisexual men in the USA were enrolled in the study over a two-year period. All participants were HIV-negative and on PrEP at the start of the trial.

The results showed that those who discontinued PrEP were more likely to be younger (in their 20s), unemployed and without health insurance.

Their reasons for stopping PrEP varied, however the most common reason was changes in their sexual behaviour. For some, this meant entering into a monogamous relationship, increasing condom use or purposefully reducing their number of sexual partners. For others it meant reducing their alcohol or drug intake.

Although results showed that the men who had discontinued PrEP were indeed engaging in less condomless anal sex than those on PrEP, this did not eliminate HIV risk, as rates of condomless anal sex didn’t reach zero. As such, this group may still have a need for PrEP yet are unable to access it for other reasons.

The second most common reason for men discontinuing PrEP was around the cost of treatment. This included difficulties in getting the drug covered by health insurance – the most common reason among participants in their 20s, many of whom were out of work or transitioning between jobs.

Yet according to CDC statistics, this group also accounted for one-fifth of new HIV infections in 2015. Finding ways to make PrEP accessible to this age group could have significant strategic benefits for national HIV prevention in the USA.  

Less common reasons included side effects or the perceived long-term health effects of taking daily medication, as well as difficulty in adhering to daily dosages.

Although none of the men interviewed had intended to use PrEP permanently, participants did say that they would consider using PrEP again if they saw an increase in their HIV risk or if some of the structural barriers, such as cost, were removed.  

It is likely that as more men are enrolled on PrEP, these drop-out rates will increase. The researchers comment: ”With PrEP being the most effective bio-medical behavioural prevention strategy currently available it is imperative that research does not conclude entirely with uptake and adherence.“

The research brings up an interesting argument for ‘on demand’ PrEP, or seasonal PrEP-use during periods of someone’s life when they feel they may be more at risk – which could prove to be a more cost-effective option for people

Ultimately, understanding what drives men to take PrEP as well as what stops them from taking it will allow us to create prevention services that best suit those in need.