Social identity support, descriptive norms, and economic instability in PrEP engagement for emerging adult MSM in the United States

ABSTRACT

Rates of pre-exposure prophylaxis (PrEP) uptake for HIV prevention continue to increase rapidly among men who have sex with men (MSM) in the United States (U.S.); however, these increases have been slower among young MSM. Emerging adulthood (ages 18–25) is a time of transitions and social development, resulting in increased vulnerability to HIV. Analyzing data from a cross-sectional survey of emerging adult MSM (ages 18–25 years; n = 281) in the Mid-Atlantic urban metropolitan region of the U.S., we examined how social identity support, descriptive PrEP norms, and economic instability were related to PrEP engagement. In structural equation models, PrEP norms were directly associated with PrEP engagement (β = 0.29, 95% CI = [0.12,0.46]) and social identity support was indirectly associated with PrEP engagement through its association with descriptive PrEP norms (β = 0.18, 95% CI = [0.09,0.28]). Economic instability was not significantly associated with PrEP engagement, although a negative trend was present (β = −0.19, 95% CI = [−0.39,0.02]). Our results suggest that an integrative socioecological model is appropriate for the study of PrEP engagement among emerging adult MSM. Efforts to increase PrEP engagement should support community capacity building, amplify positive descriptive PrEP norms, and address unmet economic needs.

KEYWORDS:

• HIV
• pre-exposure prophylaxis
• emerging adults
• MSM

Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

Disclosure statement

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

Additional information

Funding

This manuscript resulted (in part) from research supported by the Centers for AIDS Research at the University of Pennsylvania [grant number: P30 AI 045008; PI Ronald Collman], Johns Hopkins University [grant number: P30 AI 094189; PI: Richard Chaisson], and the District of Columbia [grant number: P30 AI 117970; PI: Alan E. Greenberg]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. .