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

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

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

In the US, a large proportion of new HIV diagnoses occur among younger Black sexual minority men. Although PrEP has the potential to decrease the rate of HIV diagnoses, self-reports among this population suggest PrEP use may be low.

To evaluate factors contributing to PrEP nonadherence, data were sourced from the Neighborhoods and Network Cohort Study. Between 2018 and 2019, self-identified HIV-negative cisgender Black men were asked to recruit younger Black sexual minority men from their community. Study participants (N=70) were tested for HIV infection, surveyed about PrEP adherence, and evaluated for sleep quality using the Patient Health Questionnaire-9 (PHQ-9). Associations between sleep quality and PrEP adherence were adjusted on the basis of age, sexual orientation, income, and education.

Participants in the cohort had a median age of 26 (IQR, 23-28) years, 57.1% were gay, and 35.7% self-reported their sexual orientation as “other.” The cohort included participants who had completed either some college (25.7%) or had a college degree (17.1%), and the majority (51.4%) earned between $5000 and $29,000 annually.

In regard to sleep disturbances, 25.75% of the participants reported 1 to 2 disturbances weekly, 21.4% reported 3 to 4 disturbances weekly (21.4%), and 8.6% reported 5 to 7 disturbances weekly.

Participants who had 3 to 4 sleep disturbances weekly indicated PrEP nonadherence was due to the quantity of medications comprising their regimens (adjusted odds ratio [aOR], 7.59; 95% CI, 1.05-54.57), and those with 5 to 7 sleep disturbances weekly indicated nonadherence resulted from symptoms of depression (aOR, 8.91; 95% CI, 0.50-157.20).

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

“Sleep quality is an overlooked determinant of medication adherence, and [it] may negatively impact [younger Black sexual minority men’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 younger 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