Stigma associated with PrEP indirectly influences adherence to therapy through its effect on confidence in using PrEP, highlighting the moderating role of anticipated HIV stigma in this association, according to findings published in JAIDS.
“Research has linked stigma surrounding PrEP to poor HIV prevention outcomes, including PrEP adherence,” Ibrahim Yigit, PhD, and colleagues wrote. “However, there remains limited understanding of the mechanisms through which PrEP stigma affects PrEP adherence, specifically among sexual and gender minority (SGM) youth.”
Dr. Yigit and colleagues sought to explore the indirect consequence of PrEP stigma on PrEP adherence through PrEP confidence and the moderating role of anticipated HIV stigma.
Participants included 235 SGM youth aged 16- 24 who were assigned male sex at birth, self-reported HIV status as negative, and had an active PrEP prescription through the randomized controlled Prepared, Protected emPowered trial. Between 2019 and 2021, recruitment was conducted across nine clinics in the United States. The researchers examined cross-sectional indirect and conditional indirect effects using SPSS Process with CIs and 2,000 resamples employing baseline data.
“Intersectionality” of PrEP & HIV Stigmas
Dr. Yigit and colleagues reported significant indirect effects, suggesting that PrEP stigma was negatively associated with PrEP confidence. This, in turn, resulted in both monthly (indirect effects: B, -0.11; standard error [SE], 0.05; CI, -0.244 to -.032) and weekly (indirect effects: B, -0.09; SE, 0.04; CI, -0.191 to -0.014) optimal PrEP adherence. Anticipated HIV stigma moderated these indirect effects for both monthly ( B, -0.11; SE=0.08; CI, -0.315 to -0.001) and weekly ( B, -0.09; SE=0.06; CI, -0.245 to -0.001) adherence, “suggesting that the conditional indirect effects were significant at high but not low levels of anticipated HIV stigma,” the researchers wrote.
Based on their findings, Dr. Yigit and colleagues noted that SGM youth who take PrEP anticipating HIV stigma experience the compounding effects of PrEP stigma on confidence to use PrEP, which ultimately results in suboptimal adherence.
“Interventions addressing the intersectionality of PrEP and HIV stigmas, enhancing confidence, could improve PrEP adherence, particularly among SGM youth,” they wrote.
