FACTORS ASSOCIATED WITH HIV PRE-EXPOSURE PROPHYLAXIS WILLINGNESS AMONG YOUNG BLACK AND LATINO MEN WHO HAVE SEX WITH MEN (YBLMSM) AND TRANSGENDER WOMEN (TW)

• Published in: Journal of adolescent health Vol. 64; no. 2S; p. S103
• Main Authors: Wee, Kenneth, Van Eck, Kathryn, Galai, Noya, Vickroy, William, Brooks, Durryle, Castillo, Marne, Trexler, Connie, Ge, Shimataver, Carr, Rashida, Green, Anthony, Hardy, David, Celentano, David, Arrington-Sanders, Renata
• Format: Journal Article
• Language: English
• Published: New York Elsevier BV 01.02.2019
• Subjects: At risk populations; Bisexuality; Cisgender; Confidentiality; Health insurance; High risk; HIV; Homosexuality; Human immunodeficiency virus; Infections; Men who have sex with men; Minority & ethnic groups; Parents & parenting; Permission; Psychosocial factors; Risk behavior; Risk factors; Risk perception; Sampling; Sexual behavior; Sexual health; Sexually transmitted diseases; Social media; STD; Teenagers; Transgender persons; Uptake; Willingness
• ISSN: 1054-139X; 1879-1972

Purpose: New HIV infections in adolescents occur predominantly among young Black and Latinx men who have sex with men (YBLMSM) and transgender women (TW). Pre-exposure prophylaxis (PrEP) can effectively protect against HIV, yet it is underutilized in this age group. Low willingness to take PrEP is one of many identified barriers impeding widespread PrEP delivery to at-risk populations. We sought to examine sexual risk and psychosocial factors associated with willingness to take PrEP in a sample of YBLMSM/TW. Methods: YBLMSM/TW living in Baltimore; Washington, DC; and Philadelphia were recruited via social media, outreach, respondent-driven sampling, and local clinics sites. Eligible participants completed a survey including questions on sexual health, HIV risk perception (how likely to get infected with HIV), and attitudes regarding PrEP. HIV risk perception was measured in a 5 point Likert scale. Chi squared and Fisher's exact tests were used to examine bivariate relationships with willingness to use PrEP and multivariate logistic regression was used to assess adjusted associations. Data were analyzed using STATA 15 ®. Results: 91 YBLMSM/TW aged 15-24 (mean=20.4, SD=2.5) who reported being HIV-negative were recruited for the study. Most identified as gay (69%) or bisexual (20%); and cisgender (88%). Most had heard of PrEP (81%) and felt willing to take PrEP (83%); however, only 15% were currently taking it. Most (88%) reported having condomless sex with a male partner and 48% reported a recent sexually transmitted infection (STI) in the last 3 months. Despite 64% of participants believing it was unlikely for them to become infected with HIV, 70% were willing to take PrEP. Over two-thirds (68%) reported having disclosed their sexual identity to their medical provider. Most (62%) were on parental insurance, yet over half (57%) stated they would be unlikely to take PrEP if parental permission were required. Condomless sex or recent STI were not associated with willingness to take PrEP. Condomless sex was associated with high HIV risk perception (p=0.010). High HIV risk perception was associated with PrEP willingness (p=0.008). Willingness was associated with disclosure of identity to provider. YBLMSM/TW were three times more likely to be willing if they were on parental insurance (OR=3; CI 95% 0.95-9.45) but 75% less likely if they had to disclose their sexual behaviors to parents (OR=0.24; CI 95% 0.06-0.94). Final multivariate logistic regression showed disclosure to provider (AOR=5.38; CI 95% 1.17-24.6) and high risk perception (AOR=12.4; CI 95% 1.96-77.9) were significantly associated with PrEP willingness. Conclusions: This work suggests that YBLMSM/TW may underestimate their risk for HIV and that HIV risk perception is associated with willingness to take PrEP. It also suggests that key factors like disclosure of one's sexual identity to a medical provider, and concerns about confidentiality will also need to be addressed in order to improve PrEP uptake. YBLMSM/TW are willing to take PrEP. More work is needed to develop interventions that bring actual risk in-line with perceived risk and address barriers of those at-risk for HIV who are willing to take PrEP.