Human Immunodeficiency Virus Risk Research Articles

Questions on travel and sexual behaviours negatively impact ethnic minority donor recruitment: Effect of negative word-of-mouth and avoidance.

Donor selection questions differentially impacting ethnic minorities can discourage donation directly or via negative word-of-mouth. We explore the differential impact of two blood safety questions relating to (i) sexual contacts linked to areas where human immunodeficiency virus (HIV) rates are high and (ii) travelling to areas where malaria is endemic. Epidemiological data are used to assess infection risk and the need for these questions. We report two studies. Study 1 is a behavioural study on negative word-of-mouth and avoiding donation among ethnic minorities (n = 981 people from National Health Service Blood and Transplant (NHSBT) and the general population: 761 were current donors). Study 2 is an epidemiology study (utilizing NHSBT/UK Health Security Agency (UKHSA) surveillance data on HIV-positive donations across the UK blood services between1996 and 2019) to assess whether the sexual risk question contributes to reducing HIV risk and whether travel deferral was more prevalent among ethnic minorities (2015-2019). Studies 1 and 2 provide complementary evidence on the behavioural impact to support policy implications. A high proportion of people from ethnic minorities were discouraged from donating and expressed negative word-of-mouth. This was mediated by perceived racial discrimination within the UK National Health Service. The number of donors with HIV who the sexual contact question could have deferred was low, with between 8% and 9.3% of people from ethnic minorities deferred on travel compared with 1.7% of White people. Blood services need to consider ways to minimize negative word-of-mouth, remove questions that are no longer justified on evidence and provide justification for those that remain.

English

Introduction: The prison population in Peru exceeds 90,000 individuals, many of whom face conditions that increase their vulnerability to human immunodeficiency virus (HIV), such as exposure to illicit substances, risky sexual behaviors, and discrimination. Materials and Methods: A secondary analysis was carried out, using data from the 2016 national prison population census to identify factors associated with HIV risk in the incarcerated population of Peru. A total of 75,613 male inmates from prisons across the country participated, answering a comprehensive questionnaire consisting of 405 items. Multivariable regression Poisson models were used to calculate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results: Our findings revealed significant associations between HIV risk and sexual orientation, with homosexual (aPR: 5.50; CI: 2.62-11.56) and bisexual (aPR: 4.92; 95% CI: 2.26-10.72) individuals being at higher risk. Additionally, a history of tuberculosis (aPR: 2.82; 95% CI: 1.75-4.56) and sexually transmitted diseases (aPR 48.14; 95% CI: 31.07-74.56) were strongly correlated with increased HIV risk. Marital status, specifically being widowed, divorced, separated, or single, also showed a statistically significant association with HIV infection in both raw and adjusted regression models. Discussion: Our study highlights important risk factors for HIV infection among the male prison population in Peru. The identified associations will inform the development of effective health policies aimed at identifying and addressing HIV transmission within the country’s prisons. Furthermore, our findings provide a basis for future research in similar settings with a comparable male prison population profile.

Prevalence, incidence, and residual risk for human immunodeficiency virus among blood donors from 2003 to 2022 in Guangzhou, China.

China's significant population affected by HIV poses a substantial threat to blood transfusion safety. Despite advancements in blood testing techniques, a residual risk of HIV transmission persists. Accurately assessing HIV epidemic and the residual risk is vital for monitoring blood supply safety and evaluating the effectiveness of new screening tests. We conducted a retrospective analysis of HIV detection results among voluntary blood donors from 2003 to 2022. The study included data on HIV-confirmed positive donors, HIV prevalence, infection risk factors, and an incidence-window period mathematical model to estimate the residual risk of HIV. Between 2003 and 2022, HIV prevalence among blood donors in Guangzhou showed a peak-shaped trend, initially increasing before declining. The overall HIV prevalence was 18.9 infections per 100,000 donations. Male donors had a significantly higher prevalence compared with female donors. Donors aged 26-35 years had the highest prevalence. Ethnic minority donors had a higher prevalence compared with Han donors. Repeat donors had a lower prevalence compared with first-time donors. Donors from other provinces had a higher prevalence compared with local donors. During the period of 2003 to 2022, the residual risk of HIV in Guangzhou steadily decreased, reaching a notable 1 in 526,316 donations in the past two years. The HIV epidemic among blood donors in Guangzhou remains severe, but the residual risk of HIV is decreasing. Novel detection methods have proven advantageous in reducing this residual risk. Implementing additional effective measures is imperative to ensure blood safety and curb the spread of HIV.

Examining the relationships between pain symptoms and psychosocial functioning among women living with and at risk for human immunodeficiency virus using a cross-sectional psychological network analysis.

Pain is prevalent among women living with HIV (WLWH); however, research on pain experience among WLWH in the United States is limited. This study used a network analysis to simultaneously examine the relationships between pain experience and psychosocial functioning among WLWH and human immunodeficiency virus (HIV)-negative women. A secondary analysis of public data from the Women's Interagency HIV Study, a U.S. longitudinal cohort study of the experiences of WLWH and women at increased risk for HIV (HIV negative), was completed. Data were from Visit 42 in 2015 and included 451 WLWH and 194 HIV-negative women who endorsed experiencing pain in the week prior to the interview. Similar to the sociodemographic characteristics of WLWH in the United States, the majority of women in the sample were racially and/or ethnically minoritized and of low socioeconomic position. Networks were modeled using measures of pain intensity, pain interference, depression symptoms, anxiety/worry symptoms, meaning in life, and emotional support. Network models for WLWH and HIV-negative women were comparable (ps > .05). Depression symptoms were a central construct (strength = 1.82 and 1.77, respectively) within the networks, and pain interference was associated with psychosocial constructs (ps < .05), while pain intensity was not (ps > .05). Meaning in life and emotional support were not directly associated with pain (ps > .05). Network findings suggest that reducing depression symptoms may result in improved pain experience and broader positive impact for WLWH and for women at increased risk of HIV. This finding is consistent with research with other pain-focused populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Systematic Review and Narrative Synthesis of Factors Affecting Pre-exposure Prophylaxis Willingness Among Black Women for HIV Prevention.

Pre-exposure prophylaxis (PrEP) can significantly reduce human immunodeficiency virus (HIV) transmission among Black women in the United States (U.S.), a group disproportionately affected by HIV. However, PrEP uptake in this HIV-vulnerable population is low. This review analyzes the factors influencing Black women's PrEP willingness using the Behavioral Model for Vulnerable Populations (BMVP). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Population, Intervention, Comparison, Outcome, Study Design (PICOS) framework, we conducted a systematic literature search and selected 24 peer-reviewed studies on PrEP willingness. Narrative synthesis revealed a heterogeneous landscape of the determinants affecting PrEP willingness among Black women, categorized into three main domains. Predisposing demographic and social factors included younger age, unmarried status, higher education, sexual or gender minority identity, trust in healthcare providers, and perceived HIV risk. Predisposing behavioral factors included condomless sex, multiple partners, and engagement in sex work. Socioeconomic status, health insurance, healthcare access, support systems, and structural challenges were identified as enabling factors influencing Black women's PrEP willingness. Finally, the perceived need domain and health-related factors influencing the perceived need for PrEP included a history of sexually transmitted infections (STI), intimate partner violence (IPV), and birth control interference. This study emphasizes the complexity of the barriers and facilitators of PrEP uptake and, thus, the need for tailored interventions and health strategies to promote its use. Addressing the interconnected individual, interpersonal, and structural determinants of PrEP access is crucial for improving PrEP willingness and thereby advancing health equity in this population.

The potential of a hygiene-based message, preferred learning modalities, and *iLubricarte, Liberarte, Lavarte+!" or L 3 + for the prevention of HIV/STI in Peru.

Hygiene-based practices of lubrication, genital cleansing, postcoital urination, and rectal douching are common behaviors among populations at higher risk of human immunodeficiency virus (HIV)/sexually transmitted infections (STI). Yet, the role these behaviors have on HIV/STI risk has not been well elucidated, especially among transgender women (TW) and gay, bisexual, and other men who have sex with men (GBMSM). Additionally, advances in biomedical strategies have heralded a new era of HIV/AIDS prevention that may be accompanied by behavioral changes that lead to decreases in condom usage and subsequent changes to STI sequelae. Nevertheless, many people at higher risk are not benefiting equally from these options, strengthening the need for more sustainable, evidence-based methods. This study explored the knowledge, attitudes, and behaviors of hygiene-based practices, proven preventative methods, and preferred learning methods among Peruvian TW and GBMSM. 30 interviews and 50 questionnaires were conducted with TW (N=35), GBMSM (N=35), healthcare providers (N=5), and key community informants (N=5). Most participants perceived hygiene-based practices to be common behaviors and a significant aspect of sexual wellbeing. Educational materials utilizing social media and hosting in-person events were also viewed favorably, with value to enhancing HIV/STI knowledge. Several barriers to autonomy surfaced in the data, including systemic disparities to adequate HIV/STI services, top vs. bottom social dynamics, and PrEP accessibility issues. Continued work is needed to address the barriers to the acceptability, feasibility, and potential efficacy of hygiene-based practices, biomedical/barrier strategies, and L 3 +.

Group sex and behavior change associated with the 2022 Mpox outbreak among men who have sex with men in Southern California.

The Monkeypox (Mpox) outbreak disproportionately affected sexually active gay, bisexual, and other men who have sex with men. To understand community-level changes in sexual behavior, we surveyed individuals in a semi-urban area in Southern California. Participants were recruited between October 2022 to April 2023, using palm cards, and geolocation-focused online advertisements on social media and dating apps. Eligible participants were male, ≥18 years, reported sex with men, residents of San Bernardino or Riverside counties, California, Human Immunodeficiency Virus (HIV)-negative, currently not taking pre-exposure prophylaxis (PrEP). Descriptive analyses were performed. Chi-square, Fisher's exact, and Student's T-tests examined the association between group sex behaviors and demographics. We enrolled 91 gay, bisexual, and other men who have sex with men with a median age of 35 years (range 18-70 years). Nearly half reported having participated in group sex in the past year. Overall, 48.9% of group sex participants reported changing their sexual behaviors to prevent Mpox transmission, with limiting the number of sex partners being the most reported prevention strategy (47.6%). To prevent Mpox infection, participants that engage in group sex reported limiting the number of sex partners (34.4%), using condoms for anal sex (16.7%), avoiding crowded social venues (14.3%), and asking partners about Mpox symptoms before sex (9.5%). Survey participants reported modest sexual behavior changes in response to the Mpox outbreak. Group sex may increase the risk for Mpox, HIV, and other sexually transmitted infections; therefore, public health messages should include specific discussion of safer group sex practices in sexual health promotion.

Vaginal Bacteria and Proinflammatory Host Immune Mediators as Biomarkers of Human Immunodeficiency Virus Acquisition Risk Among African Women.

Few investigations have assessed contributions of both vaginal bacteria and proinflammatory immune mediators to human immunodeficiency virus (HIV) acquisition risk in a prospective cohort. We conducted a nested case-control study of African women who participated in a randomized placebo-controlled trial of daily oral versus vaginal tenofovir-based preexposure prophylaxis for HIV infection. Vaginal concentrations of 23 bacterial taxa and 16 immune mediators were measured. Relationships between individual bacterial concentrations or immune mediators and HIV risk were analyzed using generalized estimating equations in a multivariable model. Factor analysis assessed relationships between combinations of bacterial taxa, immune mediators, and HIV acquisition risk. We identified 177 HIV pre-seroconversion visits from 150 women who acquired HIV and 531 visits from 436 women who remained HIV uninfected. Fourteen bacterial taxa and 6 proinflammatory cytokines and chemokines were individually associated with greater HIV risk after adjusting for confounders. Women with all 14 taxa versus <14 taxa (adjusted odds ratio [aOR], 4.45 [95% confidence interval {CI}, 2.20-8.98]; P < .001) or all 6 immune mediators versus <6 mediators (aOR, 1.77 [95% CI, 1.24-2.52]; P < .001) had greater risk for HIV acquisition. Factor analysis demonstrated that a bacterial factor comprised of 14 high-risk bacterial taxa (aOR, 1.57 [95% CI, 1.27-1.93]; P < 0.001) and the interferon gamma-induced protein 10 (highest quartile: aOR, 3.19 [95% CI, 1.32-7.72]; P = 0.002) contributed to the highest HIV risk. Bacterial and host biomarkers for predicting HIV acquisition risk identify women at greatest risk for HIV infection and can focus prevention efforts.

The Effect of Age on Human Immunodeficiency Virus Risk Related Behaviors among Undergraduate Students at a Historically Black College and University in the United States of America

Objective: HIV infections have taken a heavy toll on young adults in the USA. Most undergraduate students fall within the age group who are at high risk of HIV infections. The effect of age on HIV risk related behaviors among African American undergraduate students has never been investigated before. Thus, this study assessed the effect of age on HIV risk related behaviors among African American undergraduate students at a Historically Black College and University. Methods: A total of 400 respondents were randomly selected from Jackson State University of the USA, a Historically Black College and University. A cross-sectional study design was utilized from January to September, 2016. Data were collected using a validated self-administered standardized questionnaire. Chi-square test was used to see the association between age and HIV risk related behaviors. Results: Over seventy five percent of the study participants have had at least one risk behavior related to HIV infection transmission and there was significant statistical difference between students aged 18-24 years and students aged 25 years and above (p&lt;0.05). The students aged 18-24 years were more likely to participate in risk behaviors that could predispose them to HIV infections (P = 0.02). Conclusions: As the HIV related risk behaviors was higher among students aged 18-24 years old, age appropriate HIV preventive programs that are appealing to young people will be required to effectively prevent HIV infection among this vulnerable population.

Feasibility of reaching populations at high risk for HIV in community pharmacies

BackgroundGrowing evidence has shown feasibility for human immunodeficiency virus (HIV) prevention service integration in pharmacies, including HIV testing and screening for pre-exposure prophylaxis (PrEP). Yet, further work is needed to determine whether pharmacies can effectively reach those at increased risk of HIV transmission. ObjectiveWe aimed to describe the HIV risk profiles and willingness to obtain HIV prevention services from a sample of pharmacy clients. MethodsThis was a cross-sectional pilot study aimed to develop a culturally appropriate pharmacy-based PrEP delivery model among Black men who have sex with men. Two pharmacies were recruited from low-income, underserved communities and participants were recruited within pharmacies for screener and social and behavioral surveys. Individuals were grouped by PrEP eligibility due to sexual risk, injection drug use risk, or both, and demographic and willingness measures were compared. ResultsAmong 460 pharmacy clients, 81 (17.6%) would have been eligible for PrEP due to sex or injection drug use risk. Most were eligible due to sexual risk (58.0%), while a substantial proportion were eligible due to injection drug use (27.2%) or a combination of sexual and injection drug use risk behaviors (42.0%). Of these eligible, the median age was 31 years (interquartile range = 28.32) and most had ≥1 female (75.3%) or male (96.3%) partner in the past 6 months. There was high willingness to receive a free HIV test in a pharmacy (90.1%). Most were willing to screen for PrEP in a pharmacy (95.1%) despite these services not being available in the state where this study was performed. There were no differences in willingness to obtain pharmacy-based HIV prevention services across risk groups. ConclusionThis study shows that pharmacies in disadvantaged areas can serve a key role in preventing and decreasing the transmission of HIV by reaching populations with high HIV burden and providing HIV prevention services.

Geographic Patterns of Human Immunodeficiency Virus (HIV) Risk Behaviors Among Older Adults: A Strategy for Identifying Space as a Risk Exposure.

This study examined geographical patterns of HIV risk among adults aged 60 and older. The 2019 Behavioral Risk Factor Surveillance System (BRFSS) weighted data was used to analyze self-reported participation in HIV risk behaviors among older adults (n = 62,852). Logistic regression models were used on a dichotomous HIV risk variable to map the distribution of HIV risk behaviors across both census regions and divisions. The weighted model revealed significance across regions. Across all regions, identifying as female, identifying as Hispanic, and reporting not having depression were protective from participating in HIV risk behaviors. The geographic heterogeneity in patterns of high-risk behaviors among older adults are discussed, along with the implications of partner access (marital status) and emotional health (depression) that need further examination. Recommendations for additional geographic analysis are made.

Design and Proof of Concept of a Web-Based Questionnaire to Identify Patients at Risk for HIV and HCV Infection.

Despite remarkable improvement in the human immunodeficiency virus (HIV) and hepatitis C virus (HCV) care continuum, the rate of late diagnosis of HIV and HCV in high-income countries remains unacceptably high. Testing relies mainly on primary care physicians' identification of risk factors. We aimed to adapt an analogic to an online questionnaire to help HIV and HCV screening and perform a pilot study to assess its accuracy and acceptability. We used the Delphi method to adapt a previously validated analogical questionnaire to a user-friendly online tool. It aimed to identify participants who should be screened for HIV or HCV and those who should be referred for pre-exposure prophylaxis (PrEP). We then designed a proof-of-concept pilot study from July to October 2022 to test its feasibility and suitability for use on a larger scale and to assess its accuracy in identifying patients at risk for HIV or HCV or with indication for PrEP. The final questionnaire consisted of 37 questions. A total of 142 participants provided informed consent, and 102 completed the questionnaire: 41 random patients recruited at the primary care level, 10 participants recently diagnosed with HIV, 20 participants with HIV on follow-up, 21 participants from the PrEP program, and 10 patients diagnosed with HCV. The tool adequately indicated the need for testing in more than 98% of participants with confirmed HIV/HCV infections or in the PrEP program. Furthermore, it adequately assessed PrEP referral in 94% of participants already on PrEP or with known HIV infection. Participants were highly satisfied with the tool, and 98% of them recommended its use. A self-administered web-based tool to identify patients who should be tested for HIV or HCV or referred to PrEP could simplify patient selection and help reduce late diagnosis.

Implementing pathogen reduction technology while discontinuing blood donor deferral criteria for sexual risk behaviors: A simulation study.

Combining pathogen reduction technology (PRT) with blood screening may alleviate concerns over the risk of transfusion-transmitted infections (TTI) and support changes in blood donor selection to potentially increase blood availability. This study aimed to estimate the residual risk of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) transfusion-transmission in Canada after implementing PRT, while eliminating deferrals for sexual risk behaviors. A probabilistic approach that combined Bayesian networks with Monte Carlo simulations was used to estimate the risk of transfusing HIV-, HBV-, or HCV-contaminated blood components. Different scenarios were considered to compare the current residual risk after PRT implementation, with and without donor deferral criteria for sexual risk behaviors. Donor profiles and blood component outcomes were simulated based on a literature review including the prevalence and incidence of HIV, HBV, and HCV in the Canadian blood donor population; the use of current blood screening assays; and HIV, HBV, and HCV blood donor viral loads. In the universal PRT scenario (i.e., with PRT/without deferral criteria), the estimated risks of HIV, HBV, and HCV transmission were significantly lower than those in the currently observed scenario (i.e., without PRT/with deferral criteria). This risk model suggests that PRT for platelets and plasma (and eventually for RBCs when available) significantly reduces the residual risks of HIV, HBV and HCV transfusion-transmission and could enable the removal of blood donor deferral criteria for sexual risk behaviors.

Using participatory art-based methods to explore experiences and practices in sexual and reproductive health

Arts-based research is an emergent yet developing methodology in application for health research over the last few decades. Visual arts in research and practice particularly among women in marginalized settings facilitate opportunities to address intricate issues around sexual and reproductive health (SRH), some of which extend to human immunodeficiency virus (HIV) risk perceptions and acceptability and uptake of new services and health options. This paper draws on visual arts-based methods using a specific technique of journey mapping adopted in two studies and aims to demonstrate how art-based methods contribute to socio-behavioural research.

Effectiveness of Frequent Viral Load Testing Plus Additional Interventions to Prevent HIV Transmission in Heterosexual, Serodiscordant Couples - Yunnan Province, China, 2019-2021.

HIV transmission among serodiscordant couples remains a persistent issue in China. However, the practice of combining counseling with antiretroviral therapies (ART) to enhance ART adherence is not widely implemented or recommended in Chinese health guidelines. This randomized controlled trial suggests that increased follow-up, counseling, and awareness of HIV risk can enhance ART compliance, thereby maximizing treatment efficacy. Early testing and counseling of serodiscordant couples, following the identification of a human immunodeficiency virus (HIV) positive spouse, is crucial for initiating ART and reducing the risk of seroconversion in the uninfected partner. Implementing a combination of ART and adjunct counseling in China is advisable.

Barriers and facilitators to the implementation of rapid HIV testing in Canadian Emergency Departments: a mixed methods study.

1 in 7 Canadians with Human Immunodeficiency Virus (HIV) do not know their status. Patients at increased risk of HIV routinely access the emergency department (ED), yet few are tested, representing a missed opportunity for diagnosis and linkage-to-care. Rapid HIV testing provides reliable results within the same ED encounter but is not routinely implemented. The objective of this study was to identify barriers and facilitators to rapid HIV testing in Ontario EDs. We employed a mixed-methods, convergent, parallel design study including online surveys and semi-structured interviews of physicians, nurses, and allied health across four hospitals in Toronto and Thunder Bay, Ontario. Data were analyzed in equal priority using descriptive statistics for quantitative data and thematic analysisfor qualitative data guided by the Theoretical Domains framework and Capability, Opportunity, Motivation Behaviour change model. Among 187 survey respondents, 150 (80%) felt implementing rapid HIV testing would be helpful in the ED. Facilitators included availability of resources to link patients to care after testing (71%), testing early in patient encounters (41%), and having dedicated staff with lived experience support testing (34%). Motivation to offer testing included opportunities to support an underserved population (66%). Challenges to implementation included limited time during ED patient encounters (51%) and a lack of knowledge around HIV testing (42%) including stigma. Interview themes confirmed education, and integration of people with lived experience being essential to provide rapid HIV testing and linkage-to-care in the ED. Implementation of rapid HIV testing in the ED is perceived to be important irrespective of practice location or profession. Intrinsic motivations to support underserved populations and providing linkage-to-care are novel insights to facilitate testing in the ED. Streamlined implementation, including clear testing guidelines and improved access to follow-up care, is felt to be necessary for implementation.

Missed Opportunities for Preexposure Prophylaxis Initiation in Hospitalized Persons With Opioid Use Disorder and Infectious Diseases.

Hospitalizations are increasing among persons who use opioids, secondary to overdose and infections. Our study identified acute hospitalization as a reachable moment for engaging people who use drugs in increased screening and education about human immunodeficiency virus risk and prevention (preexposure prophylaxis).

HIV Knowledge and Its Associated Sociodemographic Factors among Female Sex Workers in Malaysia.

Female sex workers (FSWs) have a high risk of human immunodeficiency virus (HIV) infection. In spite of the alarming fact that a large proportion of FSWs does not have adequate HIV knowledge, the association between sociodemographic factors and HIV knowledge among FSWs have yet to be thoroughly explored in the context of Malaysia. The aims of this study are the following: i) to determine HIV knowledge and ii) to examine the associated factors of HIV knowledge. An observational cross-sectional study was conducted. Data from the Integrated Biological and Behavioral Surveillance Survey (IBBS) 2017 (n = 630) were used. The survey was carried out in all states in Malaysia and its duration was 4 months (from March 2017 to June 2017). Ordered probit regressions were utilised to shed light on the association between sociodemographic variables and levels of HIV knowledge. A large proportion of FSWs had middle-level HIV knowledge (44.1%). FSWs with tertiary-level education were 19.5% more likely to have high-level HIV knowledge compared to those without formal education. The probability of having low-level HIV knowledge was 6.8% lower among FSWs with monthly incomes of RM1,500-RM1,999 than those having incomes of ≤ RM499. Being single instead of married was associated with 7.6%-8% lower probabilities of having low- and middle-level HIV knowledge. Public health interventions to improve FSWs' HIV knowledge need to take into consideration the role of sociodemographic factors.

Doxycycline Prophylaxis to Prevent Sexually Transmitted Infections in Women

(Abstracted from N Engl J Med 2024;389:2331–2340) Around the globe, bacterial sexually transmitted infections (STIs) are increasing, with 374 million estimated annual infections of Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum. The burden of STI sequelae is disproportionately endured by women, with resulting effects such as chronic pain, pelvic inflammatory disease, ectopic pregnancy, infertility, pregnancy/fetal complications, and increased risk of human immunodeficiency virus (HIV) acquisition.

Navigating Barriers and Opportunities: Perceptions of the Non-Occupational Post-Exposure Prophylaxis Care Continuum Among Young Sexual Minority Men, Aged 17-24, in the United States.

Human immunodeficiency virus (HIV) is a public health concern among young sexual minority men (YSMM), ages 17 to 24, in the United States. Biomedical prevention methods, such as pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP), can help reduce the risk of HIV transmission among this population. However, there is limited awareness and use of nPEP by YSMM. This study aims to explore the perceptions of YSMM regarding the nPEP care continuum, which consists of three areas of focus: awareness, uptake, and linkage to other HIV prevention services. This study draws on synchronous online focus groups with a sample of 41 YSMM in the United States. Transcripts from the focus groups were analyzed using reflexive thematic analysis. Participants reported limited nPEP awareness and prior use, a process of personal appraisal of nPEP need based on HIV risk and costs, and a preference for PrEP over PEP for long-term HIV prevention. Interventions should be tailored to increase awareness of nPEP among YSMM and reduce addressable barriers to nPEP use for YSMM, including cost and confidentiality concerns, in situations where nPEP is warranted. Finally, more research is needed on how nPEP use can act as a bridge to PrEP initiation for this population.