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Factors associated with stigma related to HIV pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM)
  1. Dharma N Bhatta1,
  2. Jennifer Hecht1,2,
  3. Shelley N Facente3,4
  1. 1San Francisco AIDS Foundation, San Francisco, California, USA
  2. 2Springboard HealthLab, Berkeley, California, USA
  3. 3School of Public Health, University of California Berkeley, Berkeley, California, USA
  4. 4Facente Consulting, Richmond, California, USA
  1. Correspondence to Dr Shelley N Facente, School of Public Health, University of California Berkeley, Berkeley, California, USA; sfacente{at}berkeley.edu

Abstract

Background Pre-exposure prophylaxis (PrEP) is a noteworthy scientific development that increases the opportunities for men who have sex with men (MSM) to prevent HIV infection, but stigma is a major barrier to its uptake. This study aims to determine the associations between PrEP-related stigma and individual characteristics among MSM.

Methods Self-reported cross-sectional data were collected from routine-collected electronic healthcare record data from 4084 MSM receiving PrEP in San Francisco, California, between July 2018 and June 2020. Multivariable logistic regression was performed to determine the associations between individual characteristics and PrEP-related stigma, adjusting for age, race, gender identity, injection history, housing status and mental health status.

Results PrEP-related stigma was experienced by 9.0% of the participants in our study. PrEP-related stigma was significantly associated with being transgender or gender non-conforming (adjusted OR (AOR): 1.81, 95% CI 1.21 to 2.72), having a history of injection drug use (AOR: 2.02, 95% CI 1.18 to 3.46), being unstably housed (AOR: 1.58, 95% CI 1.11 to 2.26) and having mental health concerns (AOR: 1.99, 95% CI 1.35 to 2.92), after controlling for age, race, gender, injection history, housing status and mental health status.

Conclusion Participants who reported being transgender or gender non-conforming, having a history of injection drug use, or having mental health concerns were more likely to report experiencing PrEP-related stigma. It is crucial to develop culturally appropriate interventions to reduce PrEP-related stigma among populations who are at high risk of HIV infection and may benefit strongly from improved PrEP uptake.

  • HIV
  • pre-exposure prophylaxis
  • preventive health services
  • sexual and gender minorities
  • sexual health

Data availability statement

This analysis was completed using internal evaluation programmatic data that are not available publicly. However, code and a de-identified data set can be arranged on a case-by-case basis through request via the corresponding author.

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Data availability statement

This analysis was completed using internal evaluation programmatic data that are not available publicly. However, code and a de-identified data set can be arranged on a case-by-case basis through request via the corresponding author.

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Footnotes

  • Handling editor Joseph D Tucker

  • Twitter @ShelleyFacente

  • Contributors DNB and JH conceived of the study. JH secured the data. DNB and SNF conducted the analysis. DNB led the writing of the manuscript, and all authors reviewed and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SNF has received consulting fees from Gilead Sciences for unrelated work, but Gilead had no awareness of or input over this analysis or manuscript.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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