LOS ANGELES — Taking a daily pill to prevent HIV transmission is one of the most effective biomedical strategies available to combat the virus' spread, yet use of this health regimen remains low among vulnerable communities, according to new research from UCLA.

The study published in the journal PLOS ONE showed that more than 90% of sexually active gay and bisexual men are familiar with the regimen, known as PrEP, or pre-exposure prophylaxis, yet fewer than 8% use it. Black and Latino men have particularly low usage rates, according to the paper by by Ian Holloway, associate professor of social welfare at the UCLA Luskin School of Public Affairs.

To measure attitudes toward PrEP, researchers commissioned the Gallup analytics firm to conduct three surveys of gay and bisexual men across the United States between 2016 and 2018. During this time, the study found:

-Awareness of the regimen increased from 59.8% to 92%.

-Uptake by those eligible for PrEP rose from 4.1% to 7.8% — a rate that remains disappointingly low.

-Of those who reported using PrEP, 33.3% discontinued the regimen.

While further research is needed to fully understand reasons for low usage and high discontinuation rates, factors likely include stigma, medication costs, concerns about side effects and lack of access to health care.

In addition, "the COVID-19 pandemic has created further obstacles to PrEP access but also opportunities to talk about the sexual health and well-being of gay and bisexual men," said Holloway, faculty director of the Gay Sexuality and Social Policy Initiative at UCLA Luskin.

Alex Garner, senior health innovation strategist at Hornet, a social networking application for gay men with over 25 million users worldwide, said the study shows that "the promise of PrEP remains unrealized across the board."

"Too few gay and bisexual men across the U.S. are able to take advantage of this effective technology," Garner said. "This study tells us we have a lot more work to do to prevent HIV and end this epidemic."

Data for Holloway's paper came from the Generations Study focusing on LGBTQ health and well-being, which is led by Ilan H. Meyer of UCLA Law's Williams Institute.

FURTHER DETAILS ON THE STUDY'S METHODOLOGY AND FINDINGS:

PrEP (Pre-exposure prophylaxis) is one of the most effective biomedical HIV prevention strategies; however, use among gay and bisexual men remains low across the United States — especially among racial/ethnic minority men.

This first-of-its-kind longitudinal study explored familiarity with and attitudes toward PrEP among a national probability sample of gay and bisexual men. PrEP uptake and discontinuation were assessed among men completing three surveys across a two-year period, all of whom remained eligible for PrEP across the survey period. Increases in PrEP use between 2016 and 2018 in a national probability sample of sexually active gay and bisexual men remained modest.

"We are heartened to see an increase in PrEP familiarity in this relatively short period of time. But growth in favorable attitudes was modest, as was the increase in PrEP use among sexually-active gay and bisexual men" said Ian Holloway, PhD, LCSW, MPH, lead author of the study. He added, "The COVID-19 pandemic has created further obstacles to PrEP access but also opportunities to talk about the sexual health and well-being of gay and bisexual men."

PrEP familiarity increased considerably between 2016 and 2018, from 59.8% to 92.0%. Favorable attitudes toward PrEP increased from 68.3% to 72.7%. While PrEP use increased by 90% between the two time points (from 4.1% in 2016 to 7.8% in 2018), this represented a small percentage of overall uptake among eligible participants across time (6.6%). Among respondents who reported PrEP use in the first two time points, 33.3% subsequently discontinued PrEP use at a later wave. Holloway commented further, "It's concerning that PrEP uptake remains low and that a third of men discontinue PrEP. With new and innovative PrEP modalities like long-acting injectable PrEP coming online, we still need to know more about what factors are key to decision-making around starting and stopping PrEP."

This Gallup survey included men from three generations (18—25, 34—41, and 52—59 years) who were surveyed annually in three waves between March 2016 and March 2018 (N at wave 1 = 624). PrEP uptake and discontinuation were assessed among men completing all three surveys and who remained eligible for PrEP at all three time points (N=181).

Further findings include the following:

- At wave 1, nearly two-thirds of participants (59.8%) were familiar with PrEP. This increased at wave 2 (78.7%) and increased again at wave 3 (92%), a 54% increase from wave 1 to wave 3.

- PrEP uptake increased across all three waves: In wave 1, 4.1% of eligible participants used PrEP; by wave 3, 7.8% of those eligible used PrEP, an almost 90% increase.

- Among those who were eligible for PrEP across all waves (N=181), 13.3% used PrEP at any wave (n=24). There was 6.6% uptake over any of the three waves.

- While PrEP discontinuation in and of itself is not a negative outcome, especially in the context of calculated risk assessment, 33.3% discontinuation over any of the three waves indicates other factors may be at play.

- Of those who used PrEP at any wave, 14% used consistently across all waves, demonstrating persistence.

"We know there are disparities in PrEP uptake, but this survey proves that the promise of PrEP remains unrealized across the board," said Alex Garner, Senior Health Innovation Strategist at Hornet, a social networking application for gay men with over 25 million users worldwide. "Too few gay and bisexual men across the U.S. are able to take advantage of this effective technology. This study tells us we have a lot more work to do to prevent HIV and end this epidemic."

This research is supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD grant 1R01HD078526) and was made possible through supplemental grants from the National Institutes of Health, Office of Behavioral and Social Sciences Research and the Office of Research on Women's Health. The Generations investigators are: Ilan H. Meyer,Ph.D., (PI), David M. Frost, Ph.D., Phillip L. Hammack, Ph.D., Marguerita Lightfoot, Ph.D., Stephen T. Russell, Ph.D. and Bianca D.M. Wilson, Ph.D. (co-Investigators, listed alphabetically). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Holloway also acknowledges support from the National Institute of Mental Health (P30 MH58107) and the California HIV/AIDS Research Program (RP15-LA-007).

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