Brief Report: Intersectional Stigma Associations With Long-Acting Injectable PrEP Willingness and Preference Among...

Gay, bisexual, and other men who have sex with men (GBMSM) in the United States are disproportionately affected by the HIV epidemic. Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) represents a novel HIV prevention strategy. However, stigma remains a barrier to HIV-related prevention and care. We investigated the role of intersectional stigma in LAI-PrEP preferences among past-year PrEP-naive, HIV-negative US cisgender GBMSM.

The 2022 American Men's Internet Survey enrolled cisgender GBMSM online between October 2022 and October 2023. Using bivariate and multivariable adjusted Poisson regression with robust variance and a modified Intersectional Discrimination Index to examine associations between several forms of stigma-anticipated, day-to-day, social systems exclusion, and violence and harassment-and LAI-PrEP willingness and preference.

Among participants (N = 1196), 705 (59.0%) were willing to use any PrEP modality and 393 (32.9%) were willing to use LAI-PrEP, among whom 211 (29.9%) reported a preference for LAI-PrEP. On average, participants experienced 1.8 of 7 anticipated discrimination items, 3.9 of 7 day-to-day discrimination items, 0.2 of 3 social systems exclusion items, and 0.9 of 4 violence/harassment items. Willingness to use LAI-PrEP was associated with anticipated stigma (adjusted prevalence ratio [aPR] = 1.06; 95% confidence interval [CI] = 1.02 to 1.10; P < 0.01). Preference for LAI-PrEP was associated with anticipated stigma (aPR = 1.06; 95% CI = 1.00 to 1.12; P = 0.04), day-to-day (aPR = 1.09; 95% CI = 1.02 to 1.15; P = 0.01) stigma, and violence/harassment (aPR = 1.09; 95% CI = 1.01 to 1.18; p-0.03).

Given disproportionate HIV burden among GBMSM, a range of HIV PrEP modality options combined with efforts to address intersectional anticipated and enacted stigma among GBMSM is critical to ensure PrEP access, uptake, and adherence.