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A recent literature review highlighted “complex intersections” between intimate partner violence and PrEP care engagement among sexual minority men.

“In the past decade, [intimate partner violence] has been gradually recognized as a public health issue among [sexual minority men] and the larger LGBT populations, shifting from the traditional [intimate partner violence] paradigm in heterosexual relationships,” Chenglin Hong, PhD, wrote in AIDS Patient Care and STDs. “Evidence in the literature suggested that [sexual minority men] experience [intimate partner violence] at substantially high rates compared with heterosexual men and rates that are comparable with cisgender heterosexual women.”

Further, existing research shows associations between intimate partner violence and HIV risk and acquisition, Dr. Hong continued. However, literature on the link between intimate partner violence and PrEP primarily focuses on heterosexual women.

Dr. Hong conducted a systematic review of existing literature to assess associations between intimate partner violence and engagement in PrEP care among sexual minority men. Results revealed “critical gaps in measuring [intimate partner violence] and PrEP outcomes,” as well as varied findings on the link between intimate partner violence and PrEP care.

Intimate Partner Violence Impacts All Facets of PrEP

The literature review included Embase, PubMed, PsycINFO, Web of Science, Medline, and CINAHL. The researchers identified only 13 relevant articles, according to the study results. Most were conducted in the US (n=9), and nearly all studies (n=12) used a quantitative design and cross-sectional data.

Two of the studies specifically assessed intimate partner violence and PrEP outcomes among Black sexual minority men, while one study included young Latino sexual minority men in the US. Beyond those, three studies enrolled male couples or coupled sexual minority men.

The findings highlighted “complex intersections” between intimate partner violence and engagement in PrEP care among sexual minority men, according to Dr. Hong.

Among young Latino sexual minority men, intimate partner violence negatively correlated with high PrEP awareness (P<0.01). A separate study that assessed the correlation of PrEP awareness among Black MSM and women yielded similar findings, showing that experiencing intimate partner violence in the previous year was not statistically associated with greater awareness of PrEP.

Further, sexual minority men who reported recent intimate partner violence in a relationship were less willing to use PrEP.

“[Intimate partner violence] as a single syndemic condition was negatively correlated with willingness to use PrEP (P<0.01),” Dr. Hong wrote.

Another study that examined intimate partner violence and specific forms of PrEP showed that sexual minority men who reported physical forms of violence ranked daily oral forms of PrEP higher, while those who reported emotional forms of violence ranked daily oral PrEP lower compared with other forms of PrEP. Sexual minority men who experienced intimate partner violence ranked long-acting injectable forms of PrEP higher.

Findings regarding intimate partner violence and PrEP uptake were mixed. Multiple investigations, including one conducted during the COVID-19 pandemic, found that experiencing intimate partner violence was not associated with current PrEP use.

Finally, the limited qualitative research identified by Dr. Hong also showed mixed results. In that literature, some sexual minority men indicated that their partners might be accepting or encouraging of PrEP use, while others expressed concern that PrEP use might lead to instances of intimate partner violence.

Addressing Unknowns to Improve PrEP Uptake

“Despite the growing body of literature examining [intimate partner violence] among sexual minority men in the past decade and efforts to promote PrEP for HIV prevention among this population, there is still a paucity of studies focusing on the intersection of IPV and PrEP care engagement,” Dr. Hong wrote.

The study identified specific gaps in the literature that should be addressed in future research, Dr. Hong continued. Such gaps include the lack of acknowledgment in public health prevention of intimate partner violence as a pervasive issue for sexual minority men.

“This review is the first to summarize and synthesize the associations between [intimate partner violence] and HIV PrEP among [sexual minority men] in the literature,” Dr. Hong wrote. “The findings … suggest a multifaceted approach to address the disparities in [intimate partner violence] and HIV among [sexual minority men], such as integrating [intimate partner violence] screening and multilevel social support services within PrEP programs, promoting inclusivity in healthcare settings, and implementing culturally tailored interventions in community-based organizations.”

Key Takeaways

• Research on the link between intimate partner violence and PrEP uptake among sexual minority men is limited.
• The literature that does exist shows “complex intersections” in this group regarding intimate partner violence and awareness of PrEP, uptake and current use, and preferences regarding PrEP.
• Future research should examine the impact of screening for intimate partner violence in PrEP care on rates of uptake and persistence.