A qualitative exploration of how to support PrEP adherence among young men who have sex with men

ABSTRACT

New HIV infections disproportionately affect young men who have sex with men (YMSM). PrEP is effective in preventing HIV acquisition; however, adherence is critical and is often suboptimal among YMSM. Interventions addressing the unique PrEP adherence challenges faced by YMSM are needed. We conducted qualitative interviews with 20 HIV-negative, YMSM (ages 15-24) with a PrEP indication and 11 healthcare professionals to inform adaption of a PrEP adherence intervention (Life-Steps for PrEP) for YMSM. We explored environmental, healthcare, and individual factors influencing uptake, adherence, attitudes, and perspectives (including desired modifications) on the Life-Steps intervention. Interviews were analyzed using content analysis. Of YMSM study participants (mean age 21.6) 55% were White, 15% Hispanic, and 5% Black. Most YMSM were PrEP-experienced (70%). Healthcare professionals (6 prescribers, 1 nurse, 2 health educators, 2 other/unspecified) averaged 6.9 years of experience caring for YMSM. All described stigma as a barrier to PrEP; YMSM expressed concern around being perceived as “risky” and concern about inadvertent PrEP disclosure if family/friends found their medication, or if parental insurance was used. Difficulty with planning for potential adherence challenges were identified by both groups. YMSM highlighted benefits of a nurse-led intervention (i.e., adding “legitimacy”), but stressed need for nonjudgmental, “savvy” interventionists. YMSM expressed a desire for comprehensive YMSM-specific sexual health information. These findings informed modification and expansion of Life-Steps content. Results highlight key potential barriers, many of which center around privacy. Content that addresses PrEP stigma, disclosing PrEP use, navigating insurance, and planning ahead in a nonjudgmental environment by trusted providers emerged as important components of a YMSM-focused delivery of Life-Steps for PrEP.

KEYWORDS:

• HIV
• young men who have sex with men
• YMSM
• HIV prevention

Acknowledgements

We thank our participants for sharing their experiences with us. All authors contributed to the study conception and design, including development of data collection instruments. Data preparation and analysis were performed by Christina Psaros, Jonathan Hill-Rorie, Casey Horvitz, and Meg Quint. The first draft of the manuscript was written by Christina Psaros, Jonathan Hill-Rorie, and Meg Quint, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data are available from the authors upon request.

Additional information

Funding

Dr. Mayer has received unrestricted research grants from Gilead Sciences and Merck, Inc. and has served on scientific advisory boards for both companies. Dr. Sullivan has unrestricted research grants from Gilead Sciences and Merck and has provided non-commercial educational services to Gilead Sciences and Merck, all outside the scope of the present work. Dr. Biello has received unrestricted research grants from Merck, Inc. Dr. Safren receives royalties from books published by Oxford University Press, Guilford Publications, and Springer/Humana Press. Dr. Krakower has conducted research at Fenway Health with funds from Gilead Sciences and Merck, and has received funds from UpToDate, Inc and Virology Education for developing medication education content.