MSM in Australia Had Multiple Preferences for Mode of PrEP

Offering patients multiple options to take pre-exposure prophylaxis (PrEP) is essential to improving adherence to the medication and reducing the number of cases of HIV, according to a new study published in AIDS and Behavior.¹ The researchers found that men who had sex with men (MSM) had preferences for multiple different forms of PrEP.

HIV prevention has been made easier with the introduction of PrEP, which is capable of a prevention rate of 99% when taken consistently.² Oral PrEP has been the most accessible form of PrEP, but there are still problems with adherence that prevent full elimination of HIV. Injectable forms of PrEP have become available in recent years and have shown promise in increasing adherence in some countries due to their less frequent dosing. With these new options for PrEP available, this study aimed to assess the preferences of PrEP for MSM to help evaluate demand and implementation.

The researchers used data from the PrEP APPEAL Study, which was conducted between May and November 2022. Participants of the APPEAL Study who lived in Australia were included in the current analysis. Adults aged 18 years or older, self-identified as MSM or had sex with a man in the previous 6 months, and self-reported as not living with HIV were included in the study.

All participants were asked if they had any knowledge of oral PrEP or long-acting injectable cabotegravir (CAB-LA) and whether they had ever taken PrEP. Participants were also asked which method of PrEP they would use if all were available and had similar efficacy. Lastly, participants were asked about the reasons they would consider CAB-LA specifically, as it was the only long-acting injectable form of PrEP available at the time of the survey.

There were 1687 participants included in this study who had a mean (SD) age of 40.2 (12.7) years and who mostly identified as gay (76.7%). A total of 55.1% had a university degree, and 42.9% were in a romantic relationship.

A total of 96.9% of the participants had heard of PrEP, of which 90.9% had heard of daily oral PrEP, 76.9% had heard of event-driven PrEP, and only 21.7% had heard of CAB-LA. There were 44.5% of the participants who were actively taking PrEP, and 63.4% had taken PrEP at some point.

Injectable PrEP was favored by 53.4% of all the participants, with 25.1% preferring the injections every 2 months and 50.6% preferring an injection every 6 months. The monthly oral pill was the most popular of the non-injectable options, with 61.6% preferring it. The daily oral pill saw 41.6% preferring it compared with 33.7% who preferred a removable implant and 35.7% who preferred event-driven oral PrEP.

Not needing to remember pills was the top reason that participants said that they would consider CAB-LA (65.0%), followed by having protection from HIV (63.8%) and longer-term protection compared with other forms of PrEP (46.9%). Not knowing enough about CAB-LA (46.7%) and the cost of CAB-LA (44.6%) were the top concerns for participants. A total of 40.3% of the participants preferred the option of switching back and forth between long-acting PrEP injections and other forms of PrEP.

Participants who had a university degree were more likely to express interest in CAB-LA (OR, 1.49; 95% CI, 1.19-1.87). Interest was also more prevalent in those who had taken PrEP (OR, 3.17; 95% CI, 2.42-4.14), those who had 11 or more male sexual partners in the last 6 months (OR, 2.09; 95% CI, 1.65-2.65), believed that friends or sex partners were taking PrEP (OR, 2.59; 95% CI, 2.02-3.33), and those who had a diagnosis of an STI in the previous year (OR, 1.41; 95% CI, 1.06-1.87).

There were some limitations to this study. Most of the participants had experience with PrEP, which could have biased their motivation to take PrEP and increased their awareness of the methods of PrEP. Participants were asked about both CAB-LA and a 6-month injection in the same question, which could have biased participants toward the injection that worked longer. Hypothetical options could have been favored in comparisons between the oral pills and a hypothetical 6-month injection or implant due to the idealization of the hypothetical.

“More advocacy is needed to ensure as new PrEP options emerge, they should be accessible to those at need to increase prevention coverage and end HIV transmission,” the authors concluded.

References

1. Chan C, Schmidt HM, Ong JJ, et al. Assessing demand for long-acting injectable PrEP and emerging PrEP options for HIV prevention in Australia: results from a cross-sectional survey of men who have sex with men. AIDS Behav. Published online November 17, 2025. doi:10.1007/s10461-025-04969-4

2. Talk PrEP together. CDC. Updated February 18, 2025. Accessed November 17, 2025. https://www.cdc.gov/stophivtogether/hiv-prevention/prep.html