HIV PrEP Stigma and the Acceptability of Long-Acting Options

In "HIV PrEP Stigma and the Acceptability of Long-Acting Options," the faculty examine the stigma and anxiety that still surround PrEP and whether long-acting options can change that.

Dr. Cocohoba asks whether patients still experience PrEP-associated stigma and anxiety. Dr. Urbina says they do. Oral PrEP remains closely tied to HIV, and patients worry that a pill bottle could label them as promiscuous. Some fear others will assume they are taking it as treatment for HIV. He calls this stigma unfortunate and a real barrier to patients coming in. Dr. Cocohoba confirms the same pattern on the West Coast. She worries that stigma is even greater among people who never reach a PrEP clinic, where it may be the very reason they do not seek care.

Dr. Urbina hopes long-acting injectables can untether patients from the pill bottle. Without a prescription to pick up or a bottle to hide at home, patients have more control over disclosure. Dr. Cocohoba adds that some anxiety is everyday worry about whether a dose was taken. Because a health care professional administers the injection, patients are always on time and can feel confident they are protected.

Dr. Cocohoba then asks what evidence exists on the acceptability of long-acting PrEP in the populations most in need. Dr. Urbina notes that in open-label extensions of registrational trials, most participants chose to continue injectables. Freedom from a daily pill fit better with their lives. However, he stresses that trial participants differ from the broader community, and more real-world data are needed. Dr. Cocohoba points to smaller pre-implementation studies suggesting that women and other groups are generally open to long-acting options. She argues that the key lies in implementation. Clinicians and health systems must identify whether the barrier in a given community is stigma, education, or medical mistrust. Sometimes the most effective intervention is simply clinician time spent addressing that community's specific concerns.

The next episode in this series, "Implementing Long-Acting HIV PrEP: Clinic and Pharmacy Infrastructure," features Dr. Urbina describing the team behind a long-acting injectable program and Dr. Cocohoba outlining what pharmacies need to deliver PrEP sustainably.