Unsuspected drug shortage is impacting the German HIV PrEP supply - results of a cross-sectional survey show: majority of PrEP users had to stop or switch to on-demand PrEP and higher unmet PrEP demand among women, diverse individuals, and those in rural or small-town areas.

BACKGROUND: To assess the implications of HIV pre-exposure prophylaxis (PrEP) shortages, we conducted a survey among PrEP users and individuals interested in PrEP. The survey explored coping strategies, HIV prevention and sexual behavior and stress levels due to the drug shortages. Furthermore, barriers to PrEP access among people with unmet PrEP demand were investigated. METHODS: An anonymous online survey was conducted from 28.01.-27.02.2024. Recruitment occurred via social media, professional societies, network channels, and flyers at HIV specialists. Factors associated with high stress levels and unmet PrEP demand were investigated using multivariable logistic regression. RESULTS: Among 926 PrEP users, most were male (98%), aged 31-45 (54%), identified as men (97%), lived in large cities (54%), and used PrEP daily (78%). Due to the shortage, 63% paused or switched to on-demand use. Most intended to resume PrEP once available (65%), followed by relying on condoms (41%) or reducing sexual partners (39%). High stress level was reported by 78%. Predictors of higher stress levels included feeling less protected against HIV and having more than 11 sexual partners; using on-demand PrEP with fewer than 20 monthly pills was significantly less likely. Unmet PrEP demand was more common among female and gender-diverse individuals and less common among those living in large cities. CONCLUSIONS: Involuntary changes in PrEP use may have hindered users' ability to adapt sexual behavior, increasing HIV risks. PrEP users most at risk and most reliant on PrEP experienced greater psychological burden. Expanding PrEP education and outreach alongside with prescriber capacity is essential to ensure PrEP continuity and meet unmet PrEP demand. Individualized counseling could help to determine actual PrEP need and benefits. CLINICAL TRIAL NUMBER: Not applicable.