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Experimental Investigation of Implicit HIV and Preexposure Prophylaxis Stigma: Evidence for Ancillary Benefits of Preexposure Prophylaxis Use

Golub, Sarit, A., PhD, MPH*,†; Lelutiu-Weinberger, Corina, PhD†,‡; Surace, Anthony, MA†,§

JAIDS Journal of Acquired Immune Deficiency Syndromes: March 1, 2018 - Volume 77 - Issue 3 - p 264–271
doi: 10.1097/QAI.0000000000001592
Prevention Research

Background: Preexposure prophylaxis (PrEP) stigma (ie, negative attitudes toward PrEP users) has been widely documented and is considered a significant barrier to implementation. However, few studies have examined PrEP stigma using implicit measures designed to reduce demand characteristics in responding. This study examined implicit PrEP- and HIV-related stigma among gay and bisexual men using geospatial social networking applications (ie, “hookup apps”).

Methods: Participants were presented with 4 simulated online profiles (pretested for comparability) paired with each of the following characteristics: HIV negative, HIV positive, on PrEP, or substance user. Participants rated the profiles on attractiveness, desirability, trustworthiness, likelihood of condom use, and riskiness of sex.

Results: There was no evidence of PrEP-related stigma, ie, participants did not rate profiles of PrEP users more negatively than profiles of HIV-negative individuals not disclosing PrEP use. However, profiles of HIV-positive individuals were rated significantly less attractive and desirable than HIV-negative or PrEP profiles. When the sample was split by history of PrEP use, negative ratings of HIV-positive profiles remained only among participants who had never taken PrEP. Participants with any history of PrEP use demonstrated no difference in ratings by HIV status.

Conclusion: These data provide the first empirical evidence for lower HIV stigma among PrEP users. Individuals who have used PrEP may “see” HIV-positive individuals differently than those without a history of PrEP use. The lack of evidence for PrEP-related stigma is encouraging and suggests that negative stereotypes about PrEP users may not extend to negative implicit judgments about them on social networking sites.

*Department of Psychology, Hunter College and the Graduate Center of the City University of New York, New York, NY;

Department of Psychology, Hunter HIV/AIDS Research Team (HART), New York, NY;

Department of Psychology, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, NJ; and

§Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI.

Correspondence to: Sarit A. Golub, PhD, MPH, Department of Psychology, Hunter HIV/AIDS Research Team (HART), Hunter College and Graduate Center of the City University of New York (CUNY), 695 Park Avenue, New York, NY 10065 (e-mail:

S.G. is funded by NIH (R01AA022077; R01MH105268), and has received study drug from Gilead Sciences for use in an NIH-funded PrEP demonstration project. C.L.W. is funded by NIH (R21MH113860). The remaining authors have no funding or conflicts of interest to disclose.

Received July 24, 2017

Accepted October 27, 2017

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.