PrEP and Adolescents: The Role of Providers in Ending the AIDS Epidemic

Abstract

Surveillance data on high school adolescent sexual activity, including teenaged pregnancy rates and incidence of sexually transmitted infections (STIs), require pediatricians and other youth providers to be competent and confident in addressing sexual and reproductive health care needs in adolescent and/or young adult populations. The American Academy of Pediatrics has published guidelines, recommendations, clinical reports, and resources on the promotion of healthy sexual development in clinical settings, encouraging sexual health assessments that are inclusive of HIV and STI testing as an integral component of comprehensive health visits. The need for a more determined effort to address sexual health as it relates to HIV specifically is evidenced by a decrease in the number of in-school youth reporting ever being tested, 15-to 24-year-olds representing 21% of new infections, and estimates that .40% of youth with HIV are undiagnosed. Ending the HIV epidemic requires adherence to published HIV testing recommendations, sexual health assessments, screening for STIs, and appropriate primary and secondary prevention education. Preexposure prophylaxis, an efficacious biomedical prevention intervention for reducing HIV acquisition, was approved in July 2012 and in May 2018 was authorized for use in minors. This state-of-the-art review article provides background information on preexposure prophylaxis, current guidelines and recommendations for use, and strategies to introduce and implement this valuable HIV prevention method in clinical practice with adolescents and young adults.

“You Don't Want Your Parents Knowing That You're Taking Pre-exposure Prophylaxis”: Pre-exposure Prophylaxis Stigma Among Black and Latinx Adolescents

“…Future studies should use mixed-methods approaches to further investigate internalized PrEP stigma among adolescents and develop targeted interventions to mitigate sexual health-related stigma. Health care providers have been identified as playing a key role in HIV prevention efforts among adolescents (Hosek & Henry-Reid, 2020). Consistent with the literature, our results suggest that health care providers may have to take special care in this role with adolescents (Blackwell, 2018).…”

Development of a tool to assess HIV prevention readiness of adolescent girls and young women in HPTN 082 study

“…Africa with high HIV incidence should be considered in a validation study to increase the generalizability of the HPRM. Likewise, validation of the HPRM in other adolescent and young populations where PrEP use is low, such as U.S. adolescents, may be valuable [39,40]. Lastly, we could not assess if the HPRM was associated with PrEP acceptance because 95% of the AGYW in HPTN 082 initiated PrEP [10].…”

Normalization of Preexposure Prophylaxis for Adolescents

“…Such normalization of PrEP is a critical first step of successful PrEP scale-up for adolescents and can be done within the context of age-appropriate sexual health education. 7 While adolescents may not often visit clinics, they do spend a great deal of time in school and in their communities with peers. Thus, endorsing PrEP in conjunction with sexual health promotion outside of VIEWPOINT clinic settings (eg, schools, social media, dating apps) could be a useful strategy to encourage broader use of the medication.…”

“…Thus, instead of determining PrEP eligibility based on vulnerability and risk, we could consider framing PrEP in the context of health promotion. Such normalization of PrEP is a critical first step of successful PrEP scale-up for adolescents and can be done within the context of age-appropriate sexual health education . While adolescents may not often visit clinics, they do spend a great deal of time in school and in their communities with peers.…”