Young people’s attitudes to Pre-Exposure Prophylaxis for HIV Prevention – a qualitative exploratory study

Abstract

Abstract Introduction Young people aged 18-24 years old are a key demographic target for eliminating human immunodeficiency virus (HIV) transmission globally. Pre-exposure prophylaxis (PrEP), a prevention medication which reduces HIV transmission, is emerging as a key tool to reduce HIV transmission. Despite largely good uptake by gay and bisexual men who have sex with men, hesitancy to use PrEP has been observed in other socio-cultural groups, such as young people, heterosexuals, people from ethnic minority backgrounds and females. Aim The aim of this study was to explore young peoples’ perceptions and attitudes to using PrEP. Methods A convenience sample of young people were recruited from England aged between 18 and 24 using a social media invitation posted by two authors which include details about the study with a registration link. Data was collected using semi-structured one-to-one interviews with graphic elicitation about current experiences of HIV care, awareness of using PrEP and decision making about accessing PrEP. Thematic analysis was used to identify codes and themes to describe participants’ experiences. Institutional ethical approval was obtained. Results Twenty-four young people took part. The sample was 58% female, 100% cisgendered, 54% had or were completing undergraduate study, 58% were straight, 58% had previously had a HIV test, 17% had previously used PrEP and a broad range of ethnicity were included. Key findings found young people had good levels of knowledge about HIV but had a poor understanding of using PrEP. In this information vacuum, negative stigma and stereotypes about HIV were transferred to using PrEP, which were reinforced by information on social media, television, and film - such as an association between using PrEP and being a promiscuous, white, gay males. In addition, young people from ethnic ethnicity communities appeared to have particularly negative attitudes to PrEP use, compared to ethnic majority counterparts. This meant the young people in our study were unable to make decisions about when to access and use PrEP. Discussion/Conclusion The findings indicate an information vacuum for young people regarding PrEP. A strength of the study is that theoretical data saturation was reached. A limitation of the study is that participants were all cisgendered and therefore the experiences of young trans people were not accounted for. Further work is needed to explore what information young people need, when and how this can be delivered to support informed decision-making about using PrEP. Pharmacists have a key role in supporting sexual health and further work should explore community pharmacies readiness to provide this information to young people.