Research explores anxiety and depression trends in Australians who take PrEP

Pre-exposure prophylaxis (PrEP) users—especially people who start PrEP but then stop—can often benefit from the receipt of anxiety and depression screenings, according to researchers in Australia.

About This Study

“Physical and mental health of long-term users of HIV pre-exposure prophylaxis (PrEP) in Australia: The X-PLORE Cohort“ was published online on Oct. 23, 2023, in AIDS. The lead author is Dr. Vincent J. Cornelisse of Department of Infectious Diseases at The Alfred Hospital in Melbourne, Australia, of the Department of Infectious Diseases at the Central Clinical School of Monash University, Australia, and of The Kirby Institute at UNSW in Sydney, Australia.

Key Research Findings

This 2021 survey assessed the impact of PrEP and the COVID-19 pandemic on the mental and physical health of 1,485 Australian X-PLORE cohort participants, 476 of whom responded (almost all cisgender men). Survey respondents had used PrEP for a median of 48 months, and 82% were still using it at the time.

Ninety-two percent of survey participants reported that their health was at least “good,” with 23% of participants saying their health had improved since starting PrEP (which the authors stated was “often due to improved mental health”); 6% reported deteriorating health, though for reasons mostly unrelated to biomedical HIV prevention. Medication-related issues occurred in 1% (low bone density) to 4% (kidney problems) of participants.

Depression was reported by 13% of participants and survey scores indicated current depression in 17% of respondents, while anxiety was reported by 15% of participants. Current depression scores were associated with a number of factors, including unemployment, younger age, monthly or more frequent cannabis use, and having discontinued PrEP. As the number of sex partners fell during the COVID-19 pandemic, 28% of participants stopped PrEP, but started up again later, and 7% of participants switched to on-demand PrEP.

Discussion Highlights and Implications for Practice

Study limitations reported by the authors included potential bias in who completed the survey because participants who stopped PrEP may have chosen not to answer, the self-reported nature of describing health outcomes, and lack of information on income, which could be protective against depression and anxiety.

The researchers speculated that the association between discontinuing PrEP and depression/anxiety could potentially be explained in several different ways. One possibility is the lack of sex–and thus no need for PrEP–because of social isolation, while another possibility is that those with depression and/or anxiety may have stopped some activities of self-care, including PrEP, and a third hypothesis is that stopping PrEP caused a re-emergence of anxiety about acquiring HIV.

Whatever the direction of the relationship between PrEP and anxiety and depression, the study authors recommended routinely screening PrEP users for mental health issues, and following up with people who stop PrEP to assess their mental health.

By Barbara Jungwirth