Barriers to preexposure prophylaxis use among individuals with recently acquired HIV infection in Northern California

Julia L. Marcus, Leo B. Hurley, Dennis Dentoni-Lasofsky, Courtney G. Ellis, Michael J. Silverberg, Sally Slome, Jonathan M. Snowden, Jonathan E. Volk

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Barriers to HIV preexposure prophylaxis (PrEP) use have not been well-characterized in people who became HIV-infected, all of whom could have benefited from PrEP. We invited Kaiser Permanente Northern California members diagnosed with HIV during 2014–2016, following a negative HIV test in the prior year, to complete a survey assessing barriers to PrEP use before HIV diagnosis. Of 268 patients surveyed, 122 (46%) responded. Median age was 36, most (84%) were men who have sex with men, and 64% were of minority racial/ethnic background. Thirty-six (30%) had discussed PrEP with a provider, of whom 10 were diagnosed with HIV at PrEP intake. Overall, only 5 (4.1%) had used PrEP, and all 5 discontinued before diagnosis. Among all respondents, the most common barrier to PrEP use was lack of PrEP awareness (51%). Among those aware of PrEP, the most common barriers were cost/insurance concerns (36%) and perceived low risk for HIV (24%). Lack of PrEP awareness ranged from 39% among those aged 25–34 to 88% among those aged <25 (P = 0.011), and from 33% among Hispanics to 69% among Blacks (P = 0.055). Increasing awareness and affordability of PrEP, and facilitating accurate assessment of HIV risk, are critical to reducing missed opportunities for PrEP.

Original languageEnglish (US)
Pages (from-to)536-544
Number of pages9
JournalAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
Issue number5
StatePublished - May 4 2019


  • Human immunodeficiency virus (HIV)
  • awareness
  • cost
  • implementation
  • preexposure prophylaxis (PrEP)

ASJC Scopus subject areas

  • Social Psychology
  • Health(social science)
  • Public Health, Environmental and Occupational Health

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