Evolving drivers of preexposure prophylaxis discontinuation among US MSM, 2018–2024
Samuel M. Jenness, Bevin Manuelpillai, Steven M. Goodreau, Julia L. Marcus, Eva A. Enns, Irah L. Lucas, Cristian Acero Martinez, Aaron J. Siegler, Travis SanchezObjective:
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 (
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;
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.