Opinions of Oral Versus Injectable HIV PrEP in a Racially Diverse Cohort

Daily oral pre-exposure prophylaxis (PrEP) safely and effectively prevents HIV infection when used as directed.

However, for some populations, taking a pill every day is not feasible. Challenges with oral PrEP uptake and adherence have driven the development of new PrEP modalities. Most significantly, long-acting injectable PrEP is now approved by the US Food and Drug Administration (FDA).

One Philadelphia-based study explored perceptions and usage of injectable versus daily HIV PrEP among a racially diverse sample of men who have sex with men (MSM). The study, “A Qualitative Exploration of New and Existing HIV PrEP Modalities Among Men Who Have Sex with Men in Philadelphia,” was presented at the recent IDWeek 2022 conference.

The investigators recruited 28 MSM, 8 Black, 10 Latinx, and 10 White, from January-May 2021. The men were all HIV-negative, lived in Philadelphia, PA, and had used social media networking sites (e.g., Facebook, Twitter, Instagram) within the past year. They collected qualitative data about this cohort using a hybrid virtual approach, with 4 focus groups and 10 semi-structured interviews. The study authors noted that they kept the focus groups racially and ethnically homogenous to best identify differences.

The MSM participants discussed their willingness to take PrEP and preference for different HIV prevention modalities. The main incentive for injectable PrEP was not having to adhere to a daily pill. Most reported disincentives for injectable PrEP included fear of needles, concerns of potential side effects, and worries of lower treatment efficacy.

The investigators specifically delineated the PrEP perceptions of Black and Latinx MSM, as these populations have disproportionately higher HIV incidence and lower PrEP uptake. The Black and Latinx MSM participants described experiencing racism and discrimination within the health care sphere, but were significantly more willing to consider intramuscular injectable PrEP if their providers gave them detailed information about the risks and benefits of the modality.

From these results, the investigators noted that there is a clear need for primary care providers to communicate accurate information about different PrEP modalities. Specifically, the authors wrote, providers should be “emphasizing ease of dosing, effectiveness, and safety of long-acting PrEP to prevent infection.” Special attention and PrEP guidance should be given to the populations most at risk of HIV infection.