Public health messaging that drives stigma around Pre-exposure Prophylaxis (PrEP), a medication that can reduce HIV risk by up to 99%, appears to play a role in uptake of the medication. Now, a new study found that among PrEP users, many fear using PrEP puts them at risk of discrimination, even when they know other people who use the medication.
The study – “A Memo on Factors Associated with Perception of Stigma Attached to PrEP: Evidence from the Keeping It LITE Study” by Shahin Davoudpour, Gregory L. Phillips II, Pedro A. Serrano, Audrey L. French and Sybil G. Hosek – appeared in Sexes.
Here, the researchers speculated about causes for self- stigma and recommends mitigation strategies to the Centers for Disease Control and Prevention (CDC), which aims to reduce new HIV infections in the US by 90% by 2030.
Unlike stigma or discrimination on their own — which have been the topics of previous research — perceived stigma is a powerful social motivator, defined as the anticipation or fear of being discriminated against. By looking at the stigmatized rather than stigmatizers, the scientists hoped to gain better insight into why uptake of the medication has been slower than anticipated, as well as why PrEP users tend to be inconsistent in taking it.
Perceived stigma can be driven by several factors, often stemming from broader societal biases and misinformation about sexual practices and HIV risk. Davoudpour’s team examined two common measures of perceived stigma in PrEP use: the assumption that PrEP users are seen as promiscuous and the perception that people who use PrEP are HIV-positive.
The study used data from the baseline survey of an online study (which enrolled participants between 2017 and 2019) of a racially diverse population of over 3,000 sexual minority men, trans men and women, and non-binary individuals in the US. The “Keeping it LITE Study” collected data about PrEP use, persistence and attitudes, which the team ran through models to assess several stigma factors.
Davoudpour called the findings “significant and counter-intuitive,” including the conclusions that perception of stigma associated with PrEP remains high among PrEP users, and that that perceived stigma is not significantly reduced by knowing others who use PrEP.
“Current PrEP users are more likely to believe that PrEP users are promiscuous — a stigma marker — than those who have never used the medication,” Davoudpour said.
“PrEP was initially promoted for individuals most vulnerable to HIV — especially those with multiple sex partners and inconsistent condom use — thus its use has been inexorably tied to promiscuity,” said co-author Phillips II. “However, PrEP can benefit a variety of people, including those in monogamous serodiscordant relationships (one partner is HIV-positive and the other is HIV-negative), but current messaging doesn’t reflect the broader array of potential PrEP users.”
Current marketing campaigns involving HIV preventatives tend to repeatedly highlight benefits of PrEP. Instead, the authors argue, “public health messaging can shift its focus to decreasing the perception of PrEP stigma among those vulnerable to HIV” via sex-positive messaging that disconnects PrEP from promiscuity and emphasizes its use among vulnerable populations.
