Assessing the effectiveness and reach of pre-exposure prophylaxis (PrEP) as an HIV prevention strategy for US men who have sex with men (MSM): a view toward optimizing PrEP impact

Abstract

This study finds evidence of pre-exposure prophylaxis (PrEP) effectiveness as an HIV preventive for men who have sex with men (MSM) at this beginning stage of intervention. Against concerns over irresponsible PrEP use arising due to altered HIV risk perception, this study finds that PrEP recipients reported no significant change in condom use and number of sex partners since starting PrEP (ie. absent sexual risk compensation) as well as high daily PrEP adherence. Differences between MSM on PrEP and not were overall few. One difference is that PrEP recipients reported slightly better mental health. This could potentially have mediated our finding of responsible PrEP use. MSM on PrEP also reported being a higher-risk group and feeling more vulnerable to HIV before taking PrEP than non-PrEP recipients. Concerning low PrEP uptake among MSM, this study proposes that principal barriers are lack of PrEP awareness and literacy, underestimation of individual HIV risk, and the high expense of PrEP. While PrEP is reaching high-risk MSM individuals, this study raises concern that the most burdened MSM communities are being overlooked.