P-306. Associations between Intersectional Stigma and Long-Acting Injectable PrEP (LAI-PrEP) Willingness and Preference among Gay, Bisexual, and other Men who have Sex with Men (GBMSM)

TL;DR

This study explores how different types of stigma affect willingness and preference for a new HIV prevention method among gay and bisexual men in the U.S.

Contribution

The study introduces a novel analysis of intersectional stigma's impact on preferences for long-acting injectable PrEP among GBMSM.

Findings

Willingness to use LAI-PrEP was associated with anticipated stigma (adjusted prevalence ratio = 1.06).

Preference for LAI-PrEP over oral PrEP was linked to day-to-day stigma (adjusted prevalence ratio = 1.07).

Participants experienced significant levels of day-to-day discrimination (4.1 out of 7 items on average).

Abstract

Gay, bisexual, and other men who have sex with men (GBMSM) in the United States (U.S.) are disproportionately impacted by the HIV epidemic. Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) represents a novel HIV prevention strategy. However, stigma remains a known barrier to HIV-related prevention and care. We investigated the role of intersectional stigma (which manifests as discrimination) in LAI-PrEP preferences among U.S. cisgender GBMSM.

The 2022 American Men’s Internet Survey (AMIS) enrolled cisgender GBMSM online between October 2022 and October 2023. Analyses were restricted to participants randomized (50/50) to receive intersectional stigma questions who reported no prior HIV diagnosis or past year PrEP use and provided a valid willingness to use LAI-PrEP response. PrEP modality preference analyses were further restricted to participants who reported willingness to use at least one PrEP modality. Using bivariate and multivariable adjusted Poisson regression models with robust variance, we used a modified 21-item version of the Intersectional Discrimination Index to examine associations between several forms of stigma—anticipated, day-to-day, social systems exclusion, and violence and harassment—and LAI-PrEP willingness and preference.

Among participants (N=2314), 819 (35.4%) were willing to use any form of PrEP and (469 [20.3%] were willing to use LAI-PrEP), among whom 263 (32.1%) reported a preference for LAI-PrEP over other PrEP modalities. On average, participants experienced 1.8 of the 7 anticipated discrimination items, 4.1 of the 7 day-to-day discrimination items, 0.3 of the 3 social systems exclusion items, and 1.1 of the 4 violence/harassment items (Table 1). Willingness to use LAI-PrEP was associated with anticipated stigma (aPR=1.06; 95% CI=1.01-1.12; p=0.01). Preference for LAI-PrEP vs. oral PrEP modalities was associated with day-to-day stigma (aPR=1.07; 95% CI=1.01-1.13; p=0.02) (Table 2).

Given disproportionate HIV burden among GBMSM, HIV PrEP modality options (e.g., LAI-PrEP), which respond to diverse stigma concerns, combined with efforts to address intersectional stigma, are critical to ensure PrEP access, uptake, and adherence among GBMSM.

Travis Sanchez, DVM, MPH, ViiV Healthcare, Inc.: Grant/Research Support Supriya Sarkar, PhD, MPH, ViiV Healthcare: Stocks/Bonds (Public Company) Leigh Ragone, MS, GSK: Stocks/Bonds (Private Company)|ViiV Healthcare: Employee Vani Vannappagari, MBBS, MPH, PhD, ViiV Healthcare: Full time Employee of ViiV Healthcare and owns GSK stock|ViiV Healthcare: Stocks/Bonds (Public Company)

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