Intimate Partner Violence Victimization and HIV PrEP Adherence Among Gay, Bisexual Men, and Other Men Who Have Sex...

Intimate partner violence (IPV) is a significant barrier to HIV prevention service utilization, yet little is known about its impact on pre-exposure prophylaxis (PrEP) adherence among gay, bisexual, and other men who have sex with men (GBMSM). This study examines the association between IPV victimization and PrEP adherence using data from an online survey of 937 current PrEP users in Ukraine, conducted in early 2022, a few days before Russia's invasion. Participants reported on six types of IPV experienced in the past six months, physical, sexual, emotional, and financial abuse as well as partners' monitoring and controlling behaviors. Further, they self-reported their PrEP adherence and were asked to describe the reasons for missing PrEP medications through an open-ended question. Nearly 40% of respondents experienced at least one form of IPV, with sexual and emotional IPV being most common. Only 35.4% reported excellent or very good adherence to PrEP medication. Self-reported reasons for missed doses included COVID-19 restrictions, changes in sexual behavior, use of alternative HIV prevention methods, and health or psychological factors. In multivariable models adjusting for sociodemographic and behavioral factors, sexual IPV, monitoring, and controlling IPV were associated with higher PrEP adherence. The positive association may suggest that IPV survivors increase their PrEP adherence as a protective strategy against HIV infection. These findings highlight the importance of integrating trauma-informed IPV screening and support within PrEP programs and adopting flexible service models to sustain adherence, especially during social and political crises. Future longitudinal research should explore mechanisms linking IPV and PrEP adherence and develop structural interventions to better support this vulnerable population.