Lack of information, perceived necessity and awkwardness impact uptake of PrEP, study suggests

A new qualitative study from Bath psychologists suggests a lack of information and perceived necessity, as well as awkwardness, are impacting uptake of PrEP.

Results of a qualitative research study into the uptake of PrEP – a drug which stops HIV infecting the body – suggests that more needs to be done to breakdown barriers to access for the potentially lifesaving medication.

Research published in the Journal of Prevention and Health Promotion from a team at the University of Bath finds that knowledge and awareness among young men who have sex with other men about the drug is low and there is often stigma associated with being prescribed PrEP.

Pre-exposure prophylaxis 'PrEP' refers to a pill that prevents HIV contraction in HIV-negative individuals. PrEP can be taken daily or on-demand a day before and for two days after sex. When taken as prescribed it is 99% effective at preventing HIV transmission. Since March 2020, PrEP has also been available for free on the NHS for those at high risk of HIV.

PrEP Awareness Week and WAD23

The latest study is published during PrEP Awareness Week and on World Aids Day (Friday 1 December). It comes at a time when concerns over access to the drug, as well as HIV treatment, have been in the news.

On Thursday, results of a large-scale PrEP Impact Trial involving 24,000 PrEP users published in The Lancet suggested the drug was highly effective as a preventative treatment. On Wednesday, musician Sir Elton John spoke in Parliament urging ministers to do more to hit the target of eliminating new HIV cases by 2030.

Despite higher risks of contracting HIV, uptake of PrEP among young men who have sex with other men is low in the UK. This latest study from researchers at Bath investigated why this was the case through in-depth interviews with a small sample of young men aged between 18 – 22.

Their study highlights barriers to uptake identified by those most at risk of contracting HIV and who could benefit from the treatment. These included a lack of a perceived necessity to take PrEP, a lack of general knowledge about the drug – what it is and how it works; as well as discomfort in getting hold of the drug.

Anonymous responses from participants highlighted specific challenges. For example, some men felt that taking PrEP was unnecessary:

I always just engaged in safe sex so it's like, do I need this added preventative measure if I'm already sort of like I'm doing what I should be doing?

Others saw STI screening as a solution, without considering the possibility of contracting HIV in between testing. Participants often lacked a full picture of why and how they might use PrEP, and suggested finding it difficult to access detailed information:

I didn't know if I really needed it, like there wasn't really advertisements or like actual people or like poster advertisements telling me that I probably need PrEP.

Regarding access to PrEP, participants also referred to awkward consultations with GPs or sexual health clinics where requesting PrEP had a perceived stigma attached:

Being in person with them and they say something awkward, and you just have to sort of sit there and then leave awkwardly it's a lot more intense.

The researchers' analysis backs up a recent government review which suggests that a large proportion of young men who could be taking PrEP are not.

Against this backdrop, the researchers think more could and should be done to increase access to the drug, including through the implementation of new online services and increased education.

Dr Richard Hamshaw from the University of Bath's Department of Psychology supervised the research. He said: "Given the roll-out of PrEP, we were keen to gather views from one of the more at-risk groups (and most targeted group for PrEP uptake), young men who have sex with men.

"Carrying out in-depth interviews meant our participants could share their stories and experiences with us, and we were able to build a more detailed picture as to why some people might not use PrEP. We hope that our paper sheds further light on barriers to PrEP uptake, and hope to explore this further in future projects."

I started researching PrEP uptake after I noticed a worrying number of my LGBT+ friends were relatively unaware of the drug. Following this study, we propose enhancing such awareness by promoting stories from PrEP users about its consumption and benefits, coupled with integrating PrEP discussions into sex education in schools.

To further increase uptake amongst young men who have sex with men, we also recommend the implementation of new online services for PrEP acquisition, to simplify the process, destigmatize and increase access."

Loukas Haggipavlou, First Author