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Evolving drivers of preexposure prophylaxis discontinuation among US MSM, 2018-2024

Samuel M Jenness1, Bevin Manuelpillai1, Steven M Goodreau2

  • 1Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.

AIDS (London, England)
|August 6, 2026
PubMed
Abstract

Insights

Reasons for stopping pre-exposure prophylaxis (PrEP) among men who have sex with men shifted towards changing sexual activity and stigma, while financial barriers persisted. Tailored interventions are needed for different discontinuation profiles.

Area of Science:

  • Public Health
  • Epidemiology
  • Behavioral Science

Background:

  • Pre-exposure prophylaxis (PrEP) is a key HIV prevention strategy.
  • Understanding reasons for PrEP discontinuation is crucial for effective HIV prevention programs.
  • Temporal trends in PrEP discontinuation among men who have sex with men (MSM) require examination.

Purpose of the Study:

  • To analyze trends in reasons for stopping PrEP among US cisgender MSM from 2018 to 2024.
  • To investigate how discontinuation reasons co-occur and vary by demographics.
  • To identify distinct subgroups of PrEP discontinuation.

Main Methods:

  • Pooled repeated cross-sectional analysis of seven annual waves of the American Men's Internet Survey (AMIS) (N=54,612).
  • Analysis of 3074 noncurrent PrEP users reporting reasons for stopping.
  • Multivariable logistic regression with g-computation and latent class analysis (LCA) were used.

Main Results:

  • The most common reasons for stopping PrEP were Altered Sexual Activity (55%), Side Effects (31.6%), and Financial/Access (29.4%).
  • Altered Sexual Activity increased significantly from 46.2% to 61.2% (aOR 1.93).
  • Privacy/Discrimination concerns doubled (5.6% to 11.3%), and financial barriers remained stable; LCA identified three discontinuation profiles.

Conclusions:

  • Circumstance-driven discontinuation of PrEP became more common, while stigma-related reasons doubled and cost barriers persisted.
  • Three distinct discontinuation profiles (Changed Circumstances, Structural Barriers, Clinical/Multi-Barrier) were identified.
  • Tailored interventions, including re-engagement pathways and financial navigation, are recommended for different PrEP discontinuation profiles.
Keywords:
HIV infectionshealth services accessibilitylatent class analysismedication adherencepreexposure prophylaxissexual and gender minoritiessocial stigma

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