Sleep Quality Tied to Poor PrEP Adherence in Young Black Sexual Minority Men

Researchers sought to assess sleep quality in relation to PrEP adherence among young Black sexual minority men.

Poor quality of sleep may contribute to nonadherence to pre-exposure prophylaxis (PrEP) for HIV among young Black sexual minority men. These findings were published in the journal AIDS and Behavior.

In the US, a large proportion of new HIV diagnoses occur among young Black sexual minority men. PrEP use has the potential decrease the HIV epidemic in the US, however, this population underutilizes PrEP (55%) compared with their White counterparts (62%).

To evaluate factors contributing to PrEP underutilization, data were sourced from the Neighborhoods and Networks (N2) Cohort Study. Between 2018 and 2019, self-identified HIV-negative cisgender Black men were asked to recruit other young Black sexual minority men from their community. Study participants (N=70) were tested for HIV, surveyed about PrEP adherence, and evaluated for sleep quality using the Patient Health Questionnaire-9 (PHQ-9).

The study cohort was aged median 26 (interquartile range [IQR], 23-28) years, 57.1% were gay, and 35.7% endorsed their sexual orientation as other. The cohort had some college (25.7%) or a college degree (17.1%) and most of the cohort (51.4%) earned between $5,000 to $29,000 annually.

Individuals had some (25.75%), moderate (21.4%), or frequent (8.6%) sleep disturbances.

Individuals who had moderate levels of sleep disturbance said they missed or forgot taking their PrEP because they had too many medications to take (adjusted odds ratio [aOR], 7.59; 95% CI, 1.05-54.57) and those with frequent sleep disturbances indicated they missed their medication due to depression (OR, 11.30; 95% CI, 1.19-107.53). The relationship between adherence and depression was mitigated after adjusting for age, sexual orientation, income, and education (aOR, 8.91; 95% CI, 0.50-157.20).

The major limitation of this study was evaluating sleep quality use a single question from the PHQ-9.

“Sleep quality is an overlooked determinant of medication adherence, and may negatively impact YBSMM’s ability to consistently take PrEP,” the researchers stated. Interventions aimed at improving sleep quality, such as housing programs or education about sleep hygiene, may be potential avenues for increasing PrEP adherence in the US among young Black sexual minority men.


Pagkas-Bather J, Duncan DT, Chen Y-T, et al. Sleep Disturbance is Associated with Missing PrEP Doses Among Young Black Sexual Minority Men in The N2 study. AIDS Behav. Published online June 4, 2022. doi:10.1007/s10461-022-03711-8

This article originally appeared on Neurology Advisor