Intersectional stigma associations with long-acting injectable PrEP (LAI-PrEP) willingness and preference among cisgender gay, bisexual, and other men who have sex with men (GBMSM): A brief quantitative report

Background: – 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 barrier to HIV-related prevention and care. We investigated the role of intersectional stigma in LAI-PrEP preferences among past-year PrEP naïve, HIV-negative U.S. cisgender GBMSM.Methods: – The 2022 American Men’s Internet Survey (AMIS) enrolled cisgender GBMSM online between October 2022 and October 2023. Using bivariate and multivariable adjusted Poisson regression with robust variance and a modified 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.Results: – Among participants (N=1196), 705 (59.0%) were willing to use any PrEP modality and 393 (32.9%) were willing to use LAI-PrEP, among whom 211 (29.9%) reported a preference for LAI-PrEP. On average, participants experienced 1.8 of 7 anticipated discrimination items, 3.9 of 7 day-to-day discrimination items, 0.2 of 3 social systems exclusion items, and 0.9 of 4 violence/harassment items. Willingness to use LAI-PrEP was associated with anticipated stigma (aPR=1.06; 95% CI=1.02-1.10; p<0.01). Preference for LAI-PrEP was associated with anticipated stigma (aPR=1.06; 95% CI=1.00-1.12; p=0.04), day-to-day (aPR=1.09; 95% CI=1.02-1.15; p=0.01) stigma, and violence/harassment (aPR=1.09; 95% CI=1.01-1.18; p-0.03).Conclusions: – Given disproportionate HIV burden among GBMSM, a range of HIV PrEP modality options combined with efforts to address intersectional anticipated and enacted stigma among GBMSM is critical to ensure PrEP access, uptake, and adherence.