Characteristics Associated with HIV Pre-Exposure Prophylaxis Persistence Among Men Who Have Sex with Men in the United States: Results from the American Men’s Internet Survey,2023–2024

Abstract

We examined pre-exposure prophylaxis (PrEP) persistence and associated characteristics among a nationwide sample of US men who have sex with men (MSM). Sexually active, HIV-negative MSM aged ≥15 years were recruited online through the American Men’s Internet Survey, an annual survey; the current analysis uses cross-sectional data collected between December 2023 and August 2024. Participants reported PrEP use and duration. PrEP persistence was defined as continuous PrEP use for ≥12 months. Poisson regression models estimated associations between sociodemographic and behavioral factors and PrEP persistence. Among 3953 MSM, 40% were currently using PrEP, and 72% of those had maintained use for ≥12 months. Most participants were using daily oral PrEP, while 3.2% reported use of long-acting injectable cabotegravir. In multi-variable analyses, MSM aged 25–29 years versus ≥40 years (prevalence ratio [PR]: 0.75, 95% confidence interval [CI], 0.57, 0.98) and those without health insurance versus with private insurance (PR: 0.60, 95% CI, 0.37, 0.96) were less likely to maintain PrEP use. MSM reporting condomless anal sex (PR: 1.41, 95% CI, 1.05, 1.88) and more than one male partner (PR: 2.13, 95% CI, 1.56, 2.92) in the past year were more likely to sustain PrEP use. No associations were observed for race/ethnicity, region, illicit drug use, or mental health. Most current PrEP users reported sustained use for ≥12 months. Findings should be interpreted in light of limitations, including potential selection bias due to online recruitment. Younger and uninsured MSM had lower persistence, highlighting the need for targeted interventions to promote long-term PrEP engagement and reduce HIV risk.