Increasing the uptake of pre-exposure prophylaxis (PrEP) to prevent HIV acquisition among at-risk populations, such as young men who have sex with men (YMSM), is of vital importance to slowing the HIV epidemic. Stigma and negative injunctive norms, such as the so called ‘Truvada Whore’ phenomenon, hamper this effort. In our prior research we developed a measure of PrEP Stigma and Positive Attitudes (PSPA) and demonstrated that these injunctive norm beliefs differ by race/ethnicity and cluster geographically among YMSM in Chicago.
PSPA were measured in 622 participants in the RADAR longitudinal cohort study of YMSM and transgender women living in Chicago (YMSMT). Analyses were conducted on data from 105 YMSMT with PSPA measured at two time points 6 months apart (to assess measure stability), and 622 participants who reported on PSPA at one time point and reported on PrEP use and adherence 6 months later.
There were no significant changes in either dimension of PSPA over 6 months. Participants with higher PrEP stigma were significantly less likely to report currently taking PrEP at the next visit 6 months later (OR=0.49, 95% CI: 0.29, 0.82) while controlling for age, race and gender identity. Of those participants taking PrEP at the next visit (n=24), participants who reported missing at least one dose in the past week had significantly higher PrEP stigma scores (t=-2.39, P < .05) compared to participants who did not miss a dose in the past week. Participants with higher positive attitudes towards PrEP were significantly more likely to have reported currently taking PrEP at the next visit (OR=5.07, 95% CI: 2.42, 10.61) while controlling for age, race and gender identity.
These results provide important information about PrEP attitudes and how PrEP stigma is related to PrEP uptake and adherence. In concert with previously published cross-sectional research on PrEP stigma, these prospective findings demonstrate the importance of addressing PrEP stigma in order to improve uptake and adherence among populations in greatest need of HIV prevention interventions.