Background: Pre-exposure prophylaxis (PrEP) has been an available biomedical intervention for at-risk adolescents for over 2 years; however, progression from awareness to uptake and adherence has been slow. In response, we map adolescent men who have sex with men (AMSM) onto the PrEP Motivation Cascade to identify stages for intervention. Methods: We analyzed PrEP-related attitudinal and behavioral data from a US national cohort of 1398 AMSM. Results: A majority of the sample (53.9%) were identified as appropriate PrEP candidates. Of those identified as appropriate candidates, 51.8% were precontemplative (stage 1; unwilling to take or believing they were inappropriate candidates for PrEP), and 48.2% reached contemplation (stage 2; willing and self-identified as appropriate candidates). Only 16.3% of candidates reached preparation (stage 3; seeing PrEP as accessible and planning to initiate PrEP), and 3.1% reached PrEP action (stage 4; prescribed PrEP). Although few of the AMSM identified as appropriate candidates were on PrEP, most users (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/sexually transmitted infection testing. Conclusions: AMSM PrEP use falls short of recommended levels. PrEP campaigns are needed to raise awareness by targeting key AMSM subgroups that underestimate the appropriateness of use. Equally important, parents and health providers of AMSM should serve educational roles to help facilitate potential PrEP uptake, by motivating adolescents and giving them the skills needed to request, fill, and adhere to a prescription.
Teenagers have shown a 60% increase in identifying as gay, bisexual, queer/questioning, and pansexual (GBQP) since 2005. Although studies in the early 2000s have measured the prevalence of GBQP identities across adult populations and over time, the correlates of “coming out” as GBQP are less understood among Generation-Z teenagers (i.e., those born after 1997). We sampled 1,194 GBQP male (assigned-at-birth) teenagers aged 13–18 as part of an online HIV prevention study. Demographic (e.g., age, race/ethnicity, location, sexual identity) and social factors (e.g., school-based HIV education; religiousness; internalized stigma; lesbian, gay, bisexual, transgender victimization) were surveyed and entered into logistic regression models predicting outness to a female and/or male parental figure, as well as general others. Nearly two thirds were out to a female parental figure; nearly half were out to a male parental figure. We created three multivariable models predicting outness to general others, outness to a female parental figure, and outness to a male parental figure. Statistically significant correlates consistent across the models predicted greater outness for GBQP White teenagers relative to Black and Asian teenagers, gay-identified teenagers relative to bisexual and questioning/unsure teenagers, and GBQP teenagers reporting more experiences of victimization relative to less. Correlates that predicted reduced outness include identifying as religious, attending religious services, and reporting higher internalized sexual minority stigma. We concluded that outness among Generation-Z teenagers varied by sociocultural factors, prompting some teens to move across coming-out milestones more quickly. Most important for mental health, the findings substantiate that victimization toward out-teenagers has not relented and remains an area of concern.
Compared with non-Latino White sexual minority men, Latino sexual minority men (LSMM) have lower engagement with HIV pre-exposure prophylaxis (PrEP) and likelihood of discussing PrEP with a health care provider. The overall goal of the current study was to collect data from community stakeholders to inform the integration of culturally relevant factors into an empirically supported PrEP prevention program. Between December 2020 and August 2021, 18 interviews were conducted with 18 stakeholders with experience delivering health and social services. Themes identified are: (1) stakeholders' perspectives of new HIV infections among LSMM; (2) stakeholders' perspectives of general cultural variables; and (3) the development of culturally tailored programs. Our findings demonstrate how culturally competent stakeholders can leverage their established rapport and trust to reduce the negative effects of machismo and/or homophobia in the Latinx community to promote HIV prevention.
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