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Seasons of Risk: Why Gay and Bisexual Men Quit Taking PrEP

Entering a relationship and reducing one’s number of sexual partners are the two most common reasons why gay and bisexual men choose to discontinue pre-exposure prophylaxis (PrEP), a longitudinal study has shown.

Researchers assessed PrEP use and discontinuation in 1,071 gay and bisexual men from across the country with an online survey repeated every six months. They followed the group for two years and found that 18% of men discontinued PrEP during this time span. A total of 31 study participants provided a written explanation justifying why they decided to quit taking PrEP.

The majority of men who quit PrEP explained that they no longer needed PrEP because they engaged in fewer sexual risk behaviors. These men reduced their risk of HIV infection in a variety of ways, including entering “monogamous” relationships, using condoms with HIV-positive partners, and refraining from receptive anal sex (bottoming). One participant, a 52-year-old white male, added that he decided to quit PrEP after becoming infected with an STI.

“I found out that I had contracted chlamydia,” he said. “I had been solely focused on just avoiding HIV, and I was reminded about the many other risks. So I decided to reduce my number of sexual partners and other risky behaviors.”

Approximately one-third of men quit taking PrEP due to cost and difficulty with insurance coverage. One participant, a 22-year-old Latino male, noted that his insurance would not pay for PrEP even though he had a prescription. Another participant, a 52-year-old white male, added that he quit PrEP to save his $50 copay.

The rest of the participants – about one-fifth of men – decided to quit PrEP due to either medication side effects or adherence difficulty. Even the anticipation of future side effects was sufficient to induce one participant, a 24-year-old Latino male, to quit PrEP.

“I didn’t want to needlessly have such a powerful medication circulating in my bloodstream,” he said.

Results were published in the journal AIDS and Behavior in February. Thomas Whitfield, a doctoral student at Hunter College and lead author of the study, emphasized that researchers shouldn’t focus too narrowly on getting more people on PrEP.

“We need to go further and assess why people who are still at-risk stop taking PrEP,” said Whitfield. “We found that about half of the individuals stopped taking PrEP because they no longer perceived themselves to be at risk. It is absolutely possible that their risk behavior has changed, and some participants even stated they would begin again if their risk behavior increased, which supports the theory that gay and bisexual men have seasons of risk.”

Still, Whitfield pointed out that being in a relationship doesn’t necessarily protect against HIV infection, which is shown by the high percentage of seroconversions that take place in people in relationships.

Survey results also revealed that unemployed gay and bisexual men are nearly five times more likely to discontinue PrEP.

“There are going to be people who are in between jobs at times and it’s important they still have access to this medication,” added Whitfield. “We need to find ways to fill these gaps so that people are able to continue protecting themselves in the most effective ways. Losing your job, or not being able to afford your copay, should not put you at higher risk for HIV.”

Although PrEP continues to gain in popularity, these findings highlight that barriers to PrEP continue beyond starting the medication. As always, talking to one’s physician about risk factors for HIV infection is an important part of making informed health decisions, including whether or not to discontinue PrEP.