Abstract
Introduction: HIV pre-exposure prophylaxis (PrEP) in the form of a daily oral medication is highly effective at preventing HIV. In the United States, awareness about PrEP has steadily increased over time among individuals vulnerable to HIV, however awareness has not translated into widescale uptake. Estimates are that fewer than 20% of 1.2 million Americans for whom PrEP is indicated are utilizing it. We sought to understand how individuals moved from PrEP awareness to PrEP utilization.Methods: We conducted a series (n = 31) of in-depth interviews with young people, predominantly gay and bisexual men, ages 18–29 years old between February 2015 and January 2016, as part of the evaluation of a multi-year demonstration project funded to test innovative approaches to improve sexual health outcomes and curb the HIV epidemic in California. Interviews were audio-recorded and transcribed verbatim. We conducted a thematic analysis.Results: We present a continuum of PrEP awareness that spans three phases—basic, moderate and advanced. Participants rarely reported becoming well-informed about PrEP over the course of an initial exposure to PrEP information. Learning occurred after multiple exposures to PrEP information through numerous intersecting forms, messengers and formal and informal communication channels. Positively framed messages delivered by formal messengers emphasizing PrEP as a sensible HIV prevention strategy and explicitly communicating a regard for sexual wellness were overwhelmingly persuasive and facilitated movement to the advanced awareness phase. Once participants reached the advanced phase of PrEP awareness, uptake was possible.Conclusions: Our analysis provides insights into how PrEP awareness led to PrEP uptake among young gay and bi-sexual men. Building demand among those in the basic awareness phase took longer than those in the moderate phase. Individuals involved in formal and informal PrEP education can set reasonable expectations about whether, when and how eventual uptake may occur when keeping the continuum of PrEP awareness framework in mind. Many young, gay and bi-sexual male prospective PrEP users will benefit from positively framed messages that emphasize personal well-being, including social, sexual and emotional benefits of PrEP use.
Highlights
HIV pre-exposure prophylaxis (PrEP) in the form of a daily oral medication is highly effective at preventing HIV
We offer insights into the phases of PrEP awareness and uptake, based on qualitative interviews conducted with a sample of ethnically diverse young people, primarily gay and bi-sexual men, participating in a PrEP demonstration project in California, United States
Connecting Resources for Urban Sexual Health, or CRUSH, served people at high risk for HIV infection by expanding access to PrEP and other sexual health services within an existing HIVprimary care clinic located in the eastern region of the of the San Francisco Bay Area (East Bay)
Summary
HIV pre-exposure prophylaxis (PrEP) in the form of a daily oral medication is highly effective at preventing HIV. Pre-exposure prophylaxis (PrEP) in the form of a daily oral medication is highly effective at preventing HIV and is typically prescribed as part of a comprehensive package of services that includes routine HIV testing, counseling, and treatment for sexually transmitted infections as needed [3, 4]. In the United States, recent studies estimate that over a quarter of a million people have ever been on PrEP [7] and ∼200,000–205,000 are active consumers [8] While these estimates represent a significant increase in utilization of PrEP in the US, current levels of PrEP coverage represent only a fraction of the estimated 1.2 million people for whom it is indicated and who could potentially benefit from this prevention tool [9]. With 40% coverage among those meeting at-risk criteria and 62% adhering to PrEP, one third of new infections in the US could be prevented over the 10 years [10]
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