The PrEP Cascade in a National Cohort of Adolescent Men Who Have Sex with Men
PrEP use in adolescent men who have sex with men (AMSM) fails to reach recommended levels, according to a new paper from Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH) researchers. The paper was published in the Journal of Acquired Immune Deficiency Syndrome and led by David Moskowitz, Ph.D., research assistant professor at ISGMH and the director of the SMART Project.
Pre-exposure prophylaxis, or PrEP, is a highly effective preventive medicine for people at risk for HIV. PrEP has been an available biomedical intervention for at-risk adolescents since 2018, but progression from awareness to use and adherence has been slow due to unique barriers.
“Unlike adult men,” said co-author Andrés Alvarado-Avila, Research Study Assistant for the SMART Project, “many adolescents are dependent on their parents to obtain a prescription and maintain health behaviors. One study coming from our institute reports 60.5% of AMSM reported lack of parental support, with “parents would find out” as their main PrEP concern.”
In response to these barriers, this cohort study mapped adolescent men who have sex with men (AMSM) onto the PrEP Motivation Cascade to identify stages for intervention.
Major findings of the cohort study:
- 52% of study participants who were eligible for PrEP use were unwilling to take or believed they were inappropriate candidates for PrEP.
- 48% were willing and self-identified as appropriate study participants.
- 16% were seeing PrEP as accessible and planning to initiate PrEP use.
- 3% were prescribed PrEP.
- Although few of the AMSM identified as appropriate study participants were on PrEP, 87% reported high adherence to 4+ doses per week (Stage 5: PrEP Maintenance). Factors associated with reaching later stages were being older, being out to parents, and engaging in previous HIV/STI testing.