Lesbian, gay, and bisexual people have been able to serve openly in the military since 2011. Pre-exposure prophylaxis (PrEP) prevents HIV infection, and the CDC recommends PrEP for all at-risk individuals. Despite a safe and available medication to prevent HIV infection, military men who have sex with men (MSM) continue to be disproportionately diagnosed with HIV.
While use of PrEP increased rapidly between 2014 and 2017 among civilian MSM, a 2018 study found that only 16% of at-risk military members use PrEP. The study also found that half of military primary care providers rank their knowledge of PrEP as poor and only 29% had ever prescribed it.
In 2020, Jose Gutierrez and colleagues surveyed HIV-negative military who identified as MSM about PrEP knowledge, preferences, and experience. Over half (54.7% ) of study participants were interested in taking PrEP. The table above shows interest in eight PrEP program options categorized by previous PrEP experience. The most popular PrEP program options were daily oral tablets and injectables prescribed via telehealth appointment and delivered on military bases. Those with PrEP experience most preferred daily tablets (68%) whereas respondents without experience preferred monthly injections (80.5%)
Over one-third of study participants noted that they often felt discomfort talking about sex and sexuality with military primary care providers. Approximately 350 service members are diagnosed with HIV annually. HIV infection in the military limits members’ careers and deployment options.
Those without PrEP experience were generally unsatisfied with their level of HIV protection. Military health providers will need to explore new PrEP programs to reach these military men. Updating on base health centers to provide laboratory testing, tablet or injection PrEP, and offering telehealth appointments would serve to improve protections for these men.
Databye via Gutierrez JI, Dubov A, Altice FL, Vlahov D. Preferences for pre-exposure prophylaxis among U.S. military men who have sex with men: results of an adaptive choice based conjoint analysis study. Military Medicine Research, 2021.