31. Characteristics of Social Support Networks Among Young Men And Transgender Women of Color Receiving Pre-Exposure Prophylaxis (PrEP) For HIV Prevention

Abstract

To characterize perceived social support for young men and transgender women who have sex with men (YM/TWSM) taking HIV pre-exposure prophylaxis (PrEP) and identify persisting needs for support around PrEP uptake and adherence. HIV-negative YM/TWSM of color prescribed daily oral tenofovir-emtricitabine as PrEP for ≥ three months in Philadelphia participated in a mixed-methods study. Participants completed an egocentric sociogram survey to characterize their social support networks and identify whom they could turn to for support around PrEP use. We calculated the mean proportion of individual roles and perceived PrEP supportiveness among the networks and to identify the proportion of network members to whom the index participant disclosed their PrEP use. A subset of participants (n=30) completed individual, semi-structured interviews which further characterized the social support provided by the network members, and the rationale for identifying the PrEP-specific support figures. Interview transcripts were analyzed using an inductive open-coding approach. Participants (n=50) were 69% African-American, 24% multiracial and 12% Latino/a. Median age was 21.5 years (SD: 2.0), and 10% were transgender women. Biologic family were the most commonly cited support figures, with 75% of participants identifying ≥1 biologic family member in their support network (mean network proportion 0.37 [SD: 0.31]), followed by friends who were identified in 67% of networks (mean network proportion 0.38 [SD: 0.31]). Most individuals had disclosed their PrEP to a large proportion of their network (0.74 [SD: 0.31]), and network members were perceived to be highly supportive of the participant's PrEP use (0.87 [SD: 0.28]). Nearly all (98%) participants could identify ≥1 member they would turn to for support around PrEP. In contrast to the general support figures, these individuals were more often friends (48%) than family (36%). However, this difference was not statistically significant (p=0.22). In the interview data, the predominant forms of PrEP-related social support were concrete support such as reminders about pill taking or transportation to clinic/pharmacies; and emotional support which included encouragement to be healthy and demonstrations of love and affection. Key characteristics of PrEP-specific support figures included emotional closeness, trust, and homophily (alikeness) with respect to sexual orientation and PrEP use. Non-disclosure of PrEP use was perceived as a barrier to receiving PrEP-related support for some participants. Disclosure of PrEP use to network members was often indirect, such as posting one's PrEP status on mobile dating applications, or accidental, such as having their family members find their pills. Participants less commonly discussed PrEP disclosure in the context of direct conversations about safer sex negotiation or as a means to obtain healthcare-related support from network members. While most YM/TWSM identify PrEP-specific social support figures within their networks, our data suggest that interventions to increase PrEP adherence and persistence should include skill-building around communication, particularly with respect to disclosure of PrEP use.