# PrEP Up!: Understanding PrEP stigma to improve uptake among men who have sex with men

> **NIH NIH R21** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2020 · $169,418

## Abstract

Project Summary/Abstract
Men who have sex with men (MSM) are disproportionately affected by HIV in Guatemala. While national level
adult HIV prevalence is less than 1.0%, the most recent prevalence estimate among MSM is 10.5%. This
dramatic HIV disparity suggests that current prevention strategies are not sufficient. Pre-Exposure Prophylaxis
(PrEP) with daily tenofovir/emtricitabine safely provides high levels of protection against HIV infection if taken
correctly and has expanded the HIV prevention landscape. Global PrEP uptake has been slower than expected,
however, and PrEP acceptability among men who have sex with men (MSM) is only 58%. Promoting PrEP
requires innovative, tailored approaches grounded in contextualized understanding of the social context and
lived experiences of potential users. Among MSM, multiple levels of intersecting stigma related to HIV and
sexual orientation can deter PrEP initiation. PrEP stigma, which includes negative stereotypes of PrEP users
as having HIV and/or being irresponsible and promiscuous, also greatly inhibits PrEP acceptability and
uptake. More research on levels and manifestations of PrEP stigma are needed to inform global PrEP
promotion efforts. Mobile Health (mHealth) interventions, in particular smartphone applications (apps), can be
used to mitigate stigma. The accessibility, affordability, flexibility, and anonymity of smartphones make them a
highly appealing medium for engaging MSM and addressing PrEP stigma. Further, smartphone interventions
address issues such as transportation logistics, stigma, and confidentiality, all of which are barriers to sexual
health services among MSM in Guatemala. While still a nascent field, early evidence, including work by our
team, suggests that smartphone apps can address stigma as a barrier to health promotion among MSM by
providing information and cultivating social support. Our community research partner, Colectivo Amigos
Contra el SIDA (CAS), opened the first community-based PrEP clinic in Latin America in January 2016 and is
now planning to scale up coverage. This scale up creates a crucial need for information on barriers to PrEP
acceptability and uptake and a unique opportunity to explore PrEP stigma in the lives of MSM. The proposed
R21 aims to assess the role of stigma in PrEP acceptability to inform the design of mHealth PrEP promotion
strategies through a bidirectional process of research capacity building with UNC and CAS. In Aim 1, we will
determine the association between PrEP stigma and PrEP acceptability among MSM using a mixed
methods approach. We will conduct qualitative in-depth interviews (n=20) and a structured survey (n=200) to
obtain multiple perspectives on PreP acceptability, PrEP stigma, and smartphone use and preferences. For Aim
2, we will assess how MSM in Guatemala interact in online discussions and exchange social support
related to PrEP through online focus groups discussions. For Aim 3, we will evaluate strategies to promote
uptak...

## Key facts

- **NIH application ID:** 9914144
- **Project number:** 5R21TW011264-02
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** CLARE L BARRINGTON
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $169,418
- **Award type:** 5
- **Project period:** 2019-04-15 → 2022-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9914144

## Citation

> US National Institutes of Health, RePORTER application 9914144, PrEP Up!: Understanding PrEP stigma to improve uptake among men who have sex with men (5R21TW011264-02). Retrieved via AI Analytics 2026-06-01 from https://api.ai-analytics.org/grant/nih/9914144. Licensed CC0.

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