‘How come they don’t talk about it in school?’ Identifying adolescent barriers to PrEP use

Abstract

Although 21% of new human immunodeficiency virus (HIV) diagnoses in the United States are in youth aged 13–24 years, adolescent awareness and uptake of the HIV prevention medication pre-exposure prophylaxis (PrEP) are low. This study explores the attitudes and challenges that adolescents face while taking PrEP. Thirty interviews were conducted with Black and Latine (we use the gender-inclusive term Latine rather than Latinx for more appropriate Spanish pronunciation) students aged 15–17 who received care at school-based health centers (SBHCs) in the Bronx, NY. Transcripts were coded inductively and deductively using thematic analysis. Most participants were unaware of PrEP, but nearly all were enthusiastic when informed about it; a majority denied that they would feel any stigma when taking PrEP. Despite this high receptivity, multiple barriers were identified, particularly confidentiality from parents, low perceived need of PrEP and concerns about daily adherence and side effects. Adolescents overall were enthusiastic about the availability of PrEP and felt it empowered them to have control over their health. SBHCs were considered trusted sources of confidential, accessible care, and we believe that they can be uniquely positioned to mitigate barriers to PrEP distribution in the future.

Knowledge, Attitudes, and Utilization of HIV PrEP among Black College Students in the United States: A Systematic Review

“…Secondly, negative attitudes toward HIV PrEP by Black college students are driven by fear of PrEP side-effects, hesitancy to discuss or disclose HIV and HIV PrEP related matters, concerns about cost, stigma, and the commercials associating PrEP with sexual and gender minorities [18,19]. As a result, behaviors of Black college students are characterized by low self-perceived HIV risk, and low HIV testing also seen in other subgroups of the Black demographics [24,29,30]. Specifically, hesitancy at HIV status disclosure and HIV PrEP discussion with sexual partners emerged as a significant finding [20].…”

“…Hence, under-utilization of PrEP by Black college students is not a peculiar phenomenon. However, some studies have recommended school health centers provide access to PrEP and channel HIV prevention effort towards heterosexual males and females which may be effective in correcting the false narrative associating PrEP utilization with sexual and gender minority groups [24,30,39]. This is critical for Black college students as well, considering the high rate of new HIV infection reported among Blacks in general and specifically in young adults aged 13 to 34 years [5].…”

Black Adolescent Females’ Perceptions of PrEP for HIV Risk Reduction

“…Additionally, our results support previous findings that adherence to a daily medication may be a significant perceived barrier for adolescents. 14,24 In a meta-analysis investigating PrEP adherence among adolescents and young adults, 64% of individuals demonstrated adequate PrEP adherence, however, adherence was lower in young cisgender women. 25 This highlights the importance of close follow-up with adolescent patients who initiate PrEP, as well as consideration of injectable forms of PrEP which were approved by the FDA for use in adolescent and adult patients in December of 2021.…”