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Evolving drivers of preexposure prophylaxis
discontinuation among US MSM
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Dec 2026
Download the PDF here
Download the PDF here
PrEP at NATAP
Objective:
To examine temporal trends in reasons for stopping preexposure prophylaxis (PrEP) among MSM from 2018 to 2024, including how reasons co-occur and vary by demographics.
Design:
Pooled repeated cross-sectional analysis of seven annual waves of the American Men's Internet Survey (AMIS), a national behavioral survey of US cisgender MSM (N = 54 612).
Methods:
Among 3074 noncurrent PrEP users who reported reasons for stopping, we collapsed checklist items into six thematic categories and estimated adjusted prevalence by survey year using multivariable logistic regression with g-computation. Latent class analysis (LCA) identified subgroups with distinct discontinuation profiles.
Results:
The most common reason was Altered Sexual Activity (55%), followed by Side Effects (31.6%) and Financial/Access (29.4%). After demographic adjustment, Altered Sexual Activity rose from 46.2% in 2018 to 61.2% in 2024 [adjusted odds ratio (aOR) 1.93], and Privacy/Discrimination roughly doubled from 5.6 to 11.3%, the only reason with a significant linear trend (aOR 1.14 per year; P = 0.003).
Financial/Access remained stable at approximately 29% across all 7 years. LCA identified three classes: Changed Circumstances (35.1%), Structural Barriers (23.8%), and Clinical/Multi-Barrier-side effects (41.1%). Being uninsured was the strongest predictor of financial discontinuation (aOR 4.31).
Most noncurrent PrEP users reported a single reason (2104; 68.4%), but a substantial minority (970; 31.6%) cited multiple reasons (Table S1, https://links.lww.com/QAD/D950).
dolescents and young adults (15-24) were significantly more likely than older age groups to cite Privacy/Discrimination (aOR 2.68; 95% CI: 1.87-3.87; P < 0.001). Older adults were progressively less likely to cite Altered Sexual Activity (aOR for 55+: 0.39; 95% CI: 0.30-0.50; P < 0.001) and more likely to cite Side Effects (aOR for 45-54: 1.75; 95% CI: 1.34-2.28; P < 0.001).
Black MSM were less likely to cite Altered Sexual Activity (aOR 0.54; 95% CI: 0.42-0.70; P < 0.001) and more likely to cite Adherence Challenges (aOR 1.48; 95% CI: 1.04-2.08; P < 0.05).
Conclusions:
Over 7 years of PrEP scale-up, circumstance-driven discontinuation grew increasingly dominant while stigma-related discontinuation doubled and cost barriers persisted.
Three distinct discontinuation profiles argue for tailored approaches: re-engagement pathways for those whose circumstances change, financial navigation for structural barriers, and comprehensive clinical support for those experiencing multiple challenges.
In conclusion, these findings have implications for PrEP policy and clinical practice as the United States works toward ending the HIV epidemic . Because retention interventions can meaningfully reduce HIV incidence , understanding why people stop is essential. The growing dominance of circumstance-driven discontinuation argues for accessible re-engagement pathways. Persistent Financial/Access signals that affordability efforts must extend beyond medication to laboratory monitoring, visits, and insurance navigation , and rising stigma-related discontinuation calls for interventions targeting clinical and structural contexts, especially among younger MSM . Long-acting injectable PrEP (cabotegravir and lenacapavir ) may ease adherence and side-effect burdens, though slow rollout and high costs may sustain barriers for some. Three distinct discontinuation profiles argue against one-size-fits-all retention strategies.
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