PrEP stigma and early oral PrEP care continuum outcomes among people who inject drugs in Los Angeles and Denver.

Authors

Mehrdad Khezri, Roman Ivasiy, Fabiha Rahman, John A Schneider, Danielle C Ompad, Samuel R Friedman, Valerie A Earnshaw, Ricky N Bluthenthal, Jimi Huh, Suzan M Walters

Published in

Drug and alcohol dependence. Volume 288. Pages 113371. Sep 19, 2026. Epub Sep 19, 2026.

Abstract

Despite high HIV risk among people who inject drugs (PWID), uptake of pre-exposure prophylaxis (PrEP) remains low. Understanding the role of stigma toward PrEP use among PWID can inform interventions to improve engagement along the PrEP care continuum. We examined associations between PrEP stigma and early PrEP care continuum steps: awareness, willingness to take PrEP, and attempts to access PrEP, among PWID.
We analyzed data from 243 HIV-negative PWID recruited through community-based and peer outreach efforts in Los Angeles, California, and Denver, Colorado, between April 2021 and June 2023. Participants completed a survey assessing stigma toward PrEP, awareness of PrEP, willingness to take PrEP, and attempts to access PrEP, along with sociodemographic and behavioral factors. This study refers specifically to oral PrEP, the predominant formulation available during the study period. A 10-item PrEP stigma scale assessed attitudes and perceptions toward PrEP use. Stigma items were averaged to create a continuous score (range 0-4). Multivariable logistic regression models estimated associations between PrEP stigma and each PrEP care continuum outcome.
Overall PrEP stigma was relatively low (mean = 1.64, SD = 0.46). Sixty-three percent of participants had heard of PrEP, 46.2% reported willingness to take PrEP, and 5.0% had attempted to access PrEP. PrEP stigma was not associated with awareness of PrEP (aOR = 0.89; 95% CI: 0.46, 1.70). However, higher stigma was significantly associated with lower willingness to take PrEP; each one-point increase in stigma score was associated with 78% lower odds of willingness (aOR = 0.22; 95% CI: 0.10, 0.48). Higher stigma was also associated with lower odds of attempting to access PrEP in unadjusted analyses (OR = 0.15; 95% CI: 0.04, 0.62), but this association was not statistically significant after adjustment (aOR = 0.10; 95% CI: 0.01, 1.05).
Stigma toward PrEP, reflected in negative beliefs and social attitudes about PrEP use, remains an important barrier to willingness to initiate PrEP among PWID. Interventions addressing PrEP-related stigma may improve PrEP engagement and help reduce HIV transmission risk among PWID.

PMID:
42822173
Bibliographic data and abstract were imported from PubMed on 02 Oct 2026.

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