Preference for Long-Acting vs On-Demand PrEP Seen in Black Men in the US

Interest in on-demand pre-exposure prophylaxis (PrEP) and long-acting injectable (LAI) PrEP varied in Black sexual minority men, who are more often affected by HIV compared with other subgroups. On-demand PrEP was less enticing due to men not being able to plan activity in advance that would increase their risk of HIV, according to a study published in PLOS One.1

Black individuals and sexual minority men have the highest rates of HIV diagnoses. Black gay and bisexual men account for 49% of all Black individuals living with HIV and 30% of all gay and bisexual men living with HIV.2 Preventing HIV can be accomplished in several ways, including the use of PrEP, which can be taken in a daily oral dose or through the use of LAI PrEP. PrEP uptake is still lower than what is required to end the HIV epidemic and especially low in Black sexual minority men. This study aimed to examine which of on-demand and LAI PrEP was preferred by Black sexual minority men who were negative for HIV and their reason for that preference.

Black sexual minority men with HIV were more inclined to be receptive toward long-acting injectable PrEP | Image credit: LIGHTFIELD STUDIOS - stock.adobe.com

Focus groups were conducted between March 2022 and April 2023 in the Washington, DC, metropolitan area, both in person and virtually. The focus groups were separated into groups of current users of PrEP, non-users of PrEP, and those who discontinued use of PrEP. All participants were aged 18 years or older, identified as Black/African American, were assigned male sex at birth, lived in the Washington DC metropolitan area, and were HIV negative. Participants were recruited through the use of posters and flyers at the study site as well as outreach through community events and gay nightclubs and bars. There were 17 focus groups that were conducted with 3 to 6 individuals included in each.

There were 58 participants in the study, and 57% were between 25 and 34 years old. Cisgender men (90%) and gay/homosexual men (69%) made up the majority of the group, and 47% currently used PrEP compared with 28% who had discontinued and 26% who were not using PrEP. A total of 11% of the participants also identified as Hispanic/Latino.

Lack of interest in on-demand PrEP and acceptability of LAI-PrEP were the 2 key themes that defined the preferences of Black sexual minority men. PrEP use status correlated with different opinions on the modalities of PrEP. A total of 76% of all participants were not interested in on-demand PrEP after being provided a quick overview of its use and dosing strategy. These reasons included an inability to predict and plan sexual activity, the fear of unnecessary medication use, and not knowing how effective on-demand PrEP was.

Although on-demand PrEP received a less enthusiastic response, 82% of all participants were highly accepting of LAI-PrEP due to the convenience of taking the treatment and its potential to close the gap on adherence to daily oral PrEP. Fear of needles and the novelty of LAI-PrEP were some concerns that participants noted. Participants felt an aversion to more needles in their routine and held some mistrust of a new mode of PrEP.

Alternative modalities for PrEP were less accepted by those who were already on daily oral PrEP compared with those who had discontinued PrEP or who were not taking PrEP, believing that changing their current routine would take too much effort. LAI-PrEP was more accepted by those who were not taking PrEP and those who had discontinued due to less frequent dosing.

There were some limitations to this study. Self-report was used for this study, which could introduce social desirability bias. Adverse effects, costs, risks, and follow-up obligations were not discussed in these focus groups, which could affect the willingness to take different modalities of PrEP.

The present study helps to expand on the thoughts of Black sexual minority men when it comes to which form of PrEP they would prefer. Given the positive reception to LAI-PrEP in this study, the authors concluded that “programs to increase awareness and knowledge of LAI-PrEP among Black sexual minority men and health care providers that serve them are needed.” Making sure that health care providers know how to administer LAI-PrEP is critical to expanding use of PrEP across the country and reducing incidence of HIV.

References

1. Ogunbajo A, Euceda A, Ekundayo R, Smith J, Oke T, Hickson D. Preferences for on-demand/intermittent/event-driven and long-acting injectable (LAI) HIV pre-exposure prophylaxis (PrEP) among HIV-negative Black gay, bisexual, and other sexual minority men in the United States: a qualitative study. Plos One. Published online June 30, 2025. doi:10.1371/journal.pone.0323212

2. The impact of HIV on Black people in the United States. KFF. September 9, 2024. Accessed July 1, 2025. https://www.kff.org/hivaids/fact-sheet/the-impact-of-hiv-on-black-people-in-the-united-states/