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PrEP use among gay, bisexual, and queer men is dynamic, with no singular approach favored, and results warrant educational efforts on adaptable PrEP strategies.
“HIV PrEP guidelines recommend both daily and on-demand dosing for gay, bisexual, and queer men (GBQM) meeting additional risk criteria,” Daniel Grace, PhD, and colleagues wrote. “However, limited research explored how GBQM implement pausing, on-demand, discontinuation [of], and resumption of PrEP, including the contextual factors affecting decision-making.”
Further, previous research by Dr. Grace and colleagues has shown that some PrEP users who identify as GBQM have used different strategies for taking PrEP, including stopping, pausing, and resuming use, based on sexual activity and relationship status.
For a study published in SSM – Qualitative Research in Health, the researchers aimed to determine how GBQM modify PrEP use in various social and sexual circumstances. They conducted 109 longitudinal interviews with current and former PrEP users at three time points between 2020 and 2022
Physician’s Weekly (PW) spoke with Dr. Grace to learn more about the study results.
PW: What prompted this research?
Dr. Grace: On-demand PrEP has been suggested as an alternative to daily use for GBQM. However, limited research has qualitatively explored how GBQM make decisions about PrEP use over time, including discontinuing use or changing regimens. We wanted to understand how participants tailored their PrEP use to changing social and sexual circumstances, including barriers to PrEP continuation.
Can you describe the patterns of PrEP use you identified?
Our research identified three dynamic PrEP use trajectories: pausing, on-demand, and stopping. Pausing involved brief breaks followed by a return to daily use during heightened sexual activity. Others followed the 2-1-1 on-demand schedule, while some stopped PrEP with plans to resume if social and sexual circumstances changed.
During the COVID-19 pandemic, many participants paused PrEP when sexual activities decreased, restarting daily use when sexual engagements resumed. Others paused due to relationship changes or sexual inactivity, resuming PrEP in anticipation of sex. On-demand PrEP was adopted to manage side effects or save on the cost of PrEP. Some respondents stopped PrEP for sustained periods due to monogamy, loss of private insurance, side effects, or low perceived risk for HIV.
Participants expressed concerns regarding a lack of information on these strategies, instead relying on online sources or peers for guidance. Most participants obtained enough PrEP knowledge to adapt use appropriately.
What are the implications of your findings?
Gay, bisexual, and queer men’s use of PrEP is dynamic, with no singular approach to PrEP. Comprehensive education campaigns on adaptable PrEP use effectiveness and strategies to discontinue and resume PrEP for clinicians and GBQM should be implemented.
Healthcare systems and clinicians must offer continual sexual health tests and discussions about sexual behaviors, especially for people who pause or stop PrEP, to ensure retention in the cascade if deemed necessary. Awareness and understanding of on-demand PrEP must be increased for clinicians, as some participants indicated interest in the dosing regimen but found limited information from clinicians. Comprehensive education campaigns about the effectiveness of different PrEP-taking patterns and strategies to discontinue and resume PrEP for clinicians and GBQM should be implemented.
Since cost was identified as a factor that influenced decisions on PrEP use, we reiterate our previous call for providing free PrEP to people who stand to benefit. Doing so remains an important equity concern in and beyond communities of gay, bisexual, and other MSM.
