PrEP is not intended to be the only way of prevention to HIV, but one among other available options. The idea is that each method fits to the different profiles of those who have active sexual life. A common complaint to those that do not choose PrEP as a preventive method is the fear regarding the side effects of the drugs. However, even to those that selected PrEP, some do not fit in the routine of taking pills on a daily basis. Taking into account the diversification of profiles of the users, PrEP itself also starts to be offered in different formats.

The ingestion of one daily pill of emtricitabine/tenofovir is currently the most usual manner of prescribing the PrEP. However, three other options are currently tested. One of them consists of the injection of long-duration antiretroviral drugs that shall be taken every 1 months. There also are two alternatives of subcutaneous implants (under the skin) that gradually releases a dose of the medicines of PrEP; one of them is visible with naked eyes and the other is felt by the touch only. Both implants have duration of 12 months.

Such diversity of options to PrEP was investigated by the article “Preferences for Long-Acting Pre-exposure Prophylaxis (PrEP), Daily Oral PrEP, or Condoms for HIV Prevention Among US Men Who Have Sex with Men”[1]. The idea of such text was to attempt to detect reasons that lead to the choice for one of the methods of PrEP, also taking into account the prevention with the use of condom. The investigation method of the article consisted of a questionnaire answered via internet. The volunteers should be of age, have been born in male gender, and make sex with men.

In the total, 512 volunteers were considered eligible to the questionnaire. The questions were of multiple choice and occasionally asked for justifications of the answers.

About preference regarding the preventive method, 33.8% selected the condom, while 56.5% showed to be more receptive to PrEP. Out of the total of people that selected PrEP as the most proper preventive method, the preferences were the following:

21.5% – Implant I (12 months of duration; tactile, but invisible to eyes)
17% – Pill (Daily ingestion)
14,3% – Injectable PrEP (new injection every 2 months)
3.7% – Implant II (duration of 12 months; tactile and visible)

According to the research, the main criterion of choice for a method was the convenience. Most of the volunteers that selected a prevention method mentioned causes such as ‘the facility to use/remember”, “the integration in the routine of care”, “the administration mode”. Another important preference motivator was the privacy regarding the administration of PrEP. One of the volunteers, for example, reported: “I may take the pills and not be concerned that someone is seeing me doing so” (22 years old). About the visible implant, one of the volunteers answered: “Implants have more extensive protection and it [invisible implant] is the less noticeable option between both options of implant” (19 years old).

But the reason to avoid a method to another was continuously related to the perception that others may have of someone who uses PrEP. The reason why many were afraid regarding the visible implant was the fear of stigmatization, whether for being confused with someone with HIV, or for being judged as promiscuous.

One of the volunteers of the research affirmed the following: “The implant lasts one year and you may prove what you have in your body. It doesn’t matter to me if you may see it or not, as long as you may at least feel it, may prove to potential partners that you have it” (20 years old).

Those that selected the method of pill frequently justified their preference for feeling uncomfortable or are afraid of needles and surgical interventions. “Injections and implants seem to be less invasive and potentially more harmful. I like to have the possibility of controlling when and how to take the medicine with the immediate possibility of stopping taking it if I so desire” (24 years old), affirmed one of them.

Participants that preferred condom to any method of PrEP, the same way, justified their choice for the advantage of not using a medicine and the discomfort regarding possible side effects. In general, who preferred PrEP alleged the privacy of the method and possibility of not using the condom in all sexual intercourses.

Link to the summary of the article: https://www.ncbi.nlm.nih.gov/pubmed/27770215

Image source: https://twitter.com/CDC_HIVAIDS

[1]  Original title: “Preferences for Long-Acting Pre-exposure Prophylaxis (PrEP), Daily Oral PrEP, or Condoms for HIV Prevention Among US Men Who Have Sex with Men”.