Most men would rather get an injection rather than take PrEP daily as a pill

Dr. Lisa Sterman holds up a Truvada pill, an HIV treatment pill used to prevent infection in people at high risk of getting the AIDS virus. Jeff Chiu, AP

Currently only one form of taking a pre-exposure prophylaxis (PrEP): an oral pill taken once a day. Nevertheless, a recent study shows that people want more options on how they take the HIV fighting medication.

A team of researchers from both the University of Chicago and New York University talked to 482 HIV negative men who have sex with men about their preferences in PrEP, offering them the option of the pill, an “event driven” PrEP that would be taken prior to or immediately after sexual contact, a long-lasting injection, or a topical microbicide: a gel or suppository that would be applied to the genitals.

While a third of all respondents weren’t picky as long as the medication was effective, a long-lasting injection was preferred by 21%, followed by 11% wanting an event-driven medication.

The current one a day pill turned out to be the least preferred, with only 4.8% indicating a preference for the current method.

The men were separated into three categories: top, bottom, and versatile. Each had their own preferred choice of taking the medication.

Tops chose a penile microbicide over the other options, by 19.6%. The notion of a penile gel remains hypothetical; no such material is under development.

Work is ongoing for a rectal microbicide, and has been found to be safe for use. It has not yet been proven to be as effective as the current pill-based PrEP, nor if it would be the most effective form amongst the possible options for a microbicide versus a douche, a suppository, or even a rectally administered tablet.

The form of PrEP preferred by bottoms and those who are versatile is as a long-acting injection, chosen 32.9% of the time by bottoms and 25.3% by versatile participants. Injections are the furthest along, with work on a long-acting injectable medication called cabotegravir currently being studied.

Studies into the drug are currently underway at 43 sites in seven countries, and won’t be concluded until 2022. Researchers are hoping for FDA approval of such an injection-based medicine by 2025.

An event-driven form of PrEP was deemed safe for use in France in 2015, but the World Health Organization has not changed its initial 2015 recommendation that PrEP be taken on a daily basis.

Regardless of preference, there is not currently any form of PrEP beyond a pill in use today.

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