Barriers to using HIV pre-exposure prophylaxis (PrEP) and sexual behaviour after stopping PrEP: a cross-sectional study in Germany

Abstract

Background Persistence of individuals at risk of HIV with Pre-Exposure Prophylaxis (PrEP) is critical for its impact on the HIV epidemic. We analysed factors associated with stopping PrEP, barriers that may deter people from continuing PrEP and investigated sexual behaviour after stopping PrEP. Methods Current and former PrEP users in Germany were recruited to complete an anonymous online survey on PrEP use and sexual behaviour. Participants were recruited through dating apps, a PrEP community website, anonymous testing sites and peers. The results were analysed using descriptive methods and logistic regression. Results We recruited 4848 current and 609 former PrEP users in two study waves (July–October 2018, April–June 2019). Former PrEP users were more likely 18–29 years old than current users (adjusted OR = 1.6, 95% confidence interval (CI) 1.1–2.3). Moreover, they were more often unhappy with their sex life, which was more pronounced in former daily PrEP users (aOR = 4.5, 95% CI 2.9–7.1) compared to former on-demand users (aOR = 1.8, 95% CI 1.1–2.9, pinteraction = 0.005). The most common reason for stopping PrEP was a reduced need for PrEP (49.1%). However, 31.4% of former users identified logistic reasons and 17.5% stopped due to side effects. Former PrEP users using PrEP < 3 months were more likely to stop PrEP due to concerns over long-term side effects (32.0% vs. 22.5%, p = 0.015) and not wanting to take a chemical substance (33.2% vs. 24.0%, p = 0.020) compared to former PrEP users who used PrEP for longer. After stopping PrEP, 18.7% of former PrEP users indicated inconsistent condom use while having ≥4 sex partners within the previous 6 months. Former PrEP users with many partners and inconsistent condom use more often indicated logistic reasons for stopping (46.5% vs. 27.9%, p < 0.001) than did other former PrEP users. Conclusions To maximise persistence with PrEP we need to develop strategies for younger PrEP users, reduce logistic barriers to access PrEP, and to develop effective communication on side-effect management. Moreover, prevention strategies for people stopping PrEP are required, since some remain at high risk for HIV.

Rising rates of recent preexposure prophylaxis exposure among men having sex with men newly diagnosed with HIV: antiviral resistance patterns and treatment outcomes

“…As a retrospective study, we are also aware that the data collected might be affected by an information bias; however we believe this model of care could be translatable in other healthcare contexts with similar patient cohorts. PrEP fatigue, leading to sub-optimal PrEP adherence and subsequently discontinuation is an increasingly documented phenomenon [ 20 ]. This could impact in the future frequency of clinically relevant resistance, as numbers of individuals exposed to PrEP increase.…”

Why Do HIV Pre-Exposure Prophylaxis Users Discontinue Pre-Exposure Prophylaxis Care? A Mixed Methods Survey in a Pre-Exposure Prophylaxis Clinic in Belgium

“… 8 Patients who discontinue PrEP care are more likely to be younger and predominantly choose event-based PrEP. 18 , 19 Potential reasons for discontinuing PrEP care are a lower perceived risk for HIV, fear of side effects or experiencing logistical and financial barriers. 17 , 19 …”

“… 18 , 19 Potential reasons for discontinuing PrEP care are a lower perceived risk for HIV, fear of side effects or experiencing logistical and financial barriers. 17 , 19 …”

Underlying factors related to HIV/AIDS prevention: investigating the willingness to take pre-exposure prophylaxis among men-who-have-sex-with-men in Germany

“…Previous studies consistently found that younger respondents displayed greater willingness to take PrEP [ 61 , 64 – 66 ]. However, mixed results have been reported in studies measuring age in association with actual use of PrEP: Several studies reported that PrEP users were more likely to be of older age [ 67 , 68 ] while other studies reported a greater likelihood of usage among the younger MSM [ 69 , 70 ]. For its research purpose, which investigates the willingness to take PrEP, the current study will examine age in accordance with previous findings indicating higher willingness to take PrEP among younger MSM.…”

“…Correspondingly, findings focusing on PrEP uptake show that financial means play an important part. For instance, studies conducted in Germany when PrEP was already accessible through the healthcare system for monthly payment of 50–70 EUR and without routinely medical examinations covered by statutory insurances showed that MSM rather purchased PrEP through informal and cheaper sources than the legal market due to unaffordable costs via official providers [ 17 , 69 ], supporting the notion of higher willingness among MSM with lower income. Accordingly, we expect a negative association between income and willingness (hypothesis 4d).…”