HIV Prophylaxis Research Articles

The Syndemic of Substance Use, High-Risk Sexual Behavior, and Violence: A Qualitative Exploration of the Intersections and Implications for HIV/STI Prevention Among Key Populations in Lagos, Nigeria

BackgroundKey populations (KP) are defined groups with an increased risk of HIV due to specific higher risk behaviours. KP who use substances engage in risky behaviors that may play a co-active role in HIV transmission and acquisition in Nigeria. This qualitative study explored the 'syndemics' of substance use, sexual risk behavior, violence and HIV infection among KP who use substances.MethodsNineteen sexually active men who have sex with men [MSM] and 18 female sex workers [FSW] aged 16 years and older who use substances were purposively selected to participate in sixteen in-depth interviews and two focus groups. We utilized a syndemic framework to explore the interaction of socio-economic factors, substance use and high-risk sexual practices. The interviews were audio-recorded, transcribed, organized in NVIVO 11 and analyzed using thematic analysis.ResultsMajority (95%) were non-injection substance users (primarily alcohol and marijuana); a few KP also used cocaine and heroin. Sixty percent of participants were between 16-24 years. Substance use utilities and trajectories were heavily influenced by KP social networks. They used substances as a coping strategy for both physical and emotional issues as well as to enhance sex work and sexual activities. Key HIV/STI risk drivers in the settings of substance use during sexual intercourse that emerged from this study include multiple sexual partnerships, condom-less sex, transactional sex, intergenerational sex, double penetration, rimming, and sexual violence. Poverty and adverse socio-economic conditions were identified as drivers of high-risk sexual practices as higher sexual risks attracted higher financial rewards.Conclusions and RecommendationsFindings indicate that KP were more inclined to engage in high-risk sexual practices after the use of substances, potentially increasing HIV risk. The syndemic of substance use, high-risk sexual behavior, adverse socio-economic situations, and violence intersect to limit HIV prevention efforts among KP. The behavioural disinhibition effects of substances as well as social and structural drivers should be considered in the design of targeted KP HIV prevention programs. HIV intervention programs in Nigeria may yield better outcomes if they address the nexus of sexual risk behavior and substance use as well as knowledge and appropriate use of HIV prophylaxis.

Comparison of the Influence of Internalized Homonegativity on Sexual Risk Behavior of Men Who Have Sex with Men in Spain and Turkey

Objectives: This study aimed to understand how the association between internalized homonegativity (IH) and sexual risk behavior differed in Spain (N = 3,336) and Turkey (N = 550). Methods: We used multigroup structural equation modeling. Results: HIV and pre-exposure prophylaxis (PrEP) knowledge mediated the relationship between IH and sexual risk behavior among MSM in Spain, but not among men in Turkey. Higher HIV/PrEP knowledge was associated with higher sexual risk behavior among MSM in Spain, while among MSM in Turkey the association was in the opposite direction. Conclusions: The meaning of safe-sex may differ across contexts, and this should be taken into consideration when tailoring HIV prevention programs.

Preferences for pre-exposure prophylaxis for HIV: A systematic review of discrete choice experiments.

SummaryBackgroundWe aimed to systematically review the health preference literature using discrete choice experiments (DCEs), an attribute-based stated preference method, to investigate patient preferences for HIV pre-exposure prophylaxis (PrEP).MethodsA search in PubMed, Scopus, CINAHL, and Embase was conducted on July 1, 2021, and updated on November 3, 2021. We used two concepts to create our search strategy: (1) discrete choice experiments/conjoint analysis/best-worst scaling, and (2) HIV PrEP.The study is registered in PROSPERO (CRD42021267026).FindingsIn total, 1060 studies were identified, and 18 were included in the analysis. Various attributes were examined, including dosing regimen, type of PrEP products, side effects, other side benefits, cost, effectiveness, dispensing venue, and additional support services. Dosing frequency, cost, the effectiveness of PrEP, dispensing venue, and side effects were the most common attributes examined in DCEs. Despite significant heterogeneity in preferences across subpopulations, overall, the most important attributes were cost (28%, 5/18), effectiveness (28%, 5/18) followed by dosing frequency (17%, 3/18).InterpretationNotably, in studies where all of these three attributes were examined, some individuals would trade effectiveness for cost or vice versa. Ensuring PrEP is low cost or free, widely disseminating information of its effectiveness and advancements in reducing dosing frequency could accelerate the uptake of PrEP for those who would benefit from PrEP the most.FundingNone.

Status-Neutral Interventions to Support Health Equity for Black Sexual Minority Men.

Status-neutral care, a person-centered approach to healthcare not predicated on HIV serostatus, may improve health equity among Black sexual minority men (BSMM). We reviewed current status-neutral, HIV, and Pre-Exposure Prophylaxis (PrEP) interventions, and coded each for social-ecological focus and use of six approaches: (1) person-centered, (2) anti-stigma, (3) social support, (4) the social determinants of health (SDOH), (5) community engagement, and (6) multi-sectoral partnerships. We reviewed 25 studies, of which 3 were status-neutral. Nineteen studies utilized person-centered approaches, with several employing BSMM peers. For SDOH, financial incentives and reducing clinic-level barriers to care improved cascade outcomes. Direct text messaging, anti-stigma, social support, community-engagement, and multi-sectoral partnerships also improved outcomes in some studies. Few status-neutral programs exist and additional research is needed to identify key intervention components and mechanisms of influence. Programs targeting SDOH and multiple social-ecological levels offer promise for providing holistic care to BSMM, while addressing HIV prevention and treatment and health equity.

Approaches to STI Prevention and Control in a Highly Decentralized State: An Integrative Review.

The Spanish health system is highly decentralized and Autonomous Regions (AR) are responsible for managing and implementing the National Strategic Plan for Prevention and Control of HIV and other Sexually Transmitted Infections (STI) (2013–2020) via autonomous plans adapted to the characteristics of each region. The aim of this study is to report on actions taken to specifically address STI prevention and control in the autonomous plans within the mainframe of the National Strategic Plan. An integrative review was performed to analyse the health plans and HIV/STI plans of the Spanish AR during the period of validity of the current National Strategic Plan; 2013–2020. Plans were selected attending to specificity and whether strategies were in force during the year 2020. Our gatherings show that plans are largely focused to HIV prevention and control and, to a lesser extent, to STI prevention. The analysis on pre-existing resources for care of STI varied by region, and epidemiological surveillance systems for STI notification were not completely adopted by all of them. Particularly noteworthy are information campaigns, pre- and post-exposure prophylaxis for HIV, and prevention activities in community settings. The remarkable lack of studies concerning STI resources and investment in Spain highlights the necessity of consensus-based tools for evaluation and future planning of STI prevention and control measures. The high degree of heterogeneity among plans for prevention of HIV infection and STIs also points out a high number of different areas for improvement in the development of new AR plans in HIV/STI.

Associations between self-test and pre- or post-exposure prophylaxis of HIV among men who have sex with men in China.

This study aims to assess HIV self-testing (HIVST), pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) uptake and associations of three HIV prevention strategies among men who have sex with men (MSM) in China. This study included two stages, baseline and follow-up, and was conducted in Harbin, the capital city of Heilongjiang province in North China. MSM were recruited online and by peer-referral. Data contained an online questionnaire and sampling blood for HIV tests. The research group generated a QR code linking to the survey, and participants were asked to scan this QR code with a cellphone to fill out the questionnaire. MSM at the baseline were imparted knowledge of PrEP, PEP and condom use. Between January 2018 and March 2019, the research team enrolled 773 MSM for baseline analysis, and 699 were HIV negative at baseline. For follow-up, 62% (430/699) participants were retained. At baseline, 11.6% (50/430) of the participants was aware of PrEP and 40.9% (176/430) of PEP; 0.7% (3/430) had ever taken PrEP and 3.3% (14/430) had taken PEP. At follow-up, 77.7% (334/430) reported awareness of PrEP and 54.0% (232/430) for PEP; Only 2.6% (11/430) initiated PrEP uptake and 3.0% (13/430) for PEP. Additionally, at follow-up, only 21 participants newly conducted HIVST. Results showed that being willing to pay for PrEP and PEP uptake was associated with conducting HIVST, and initiations of two HIV prevention methods, PrEP and PEP uptake, were significantly associated with each other. Knowledge dissemination increased participant awareness and acceptance of PrEP and PEP effectively. Uptake of HIVST, PrEP, and PEP were low and associated with each other. It is promising to achieve high uptake by promoting HIVST, PrEP and PEP as one prevention package.

Comorbidity and comedication burden among people living with HIV in the United States

Objective To describe the burden of comorbid conditions and comedications among people living with HIV (PLWH) vs. people living without HIV (PLWoH). Methods This was a case–control study conducted among insured patients using administrative claims data. Adult PLWH were identified by antiretroviral therapy (ART) claims or HIV/AIDS diagnosis codes from 1 January 2018 to 31 December 2018 (index date was set by the earliest claim). Continuous enrollment was required for ≥12 months pre-index (baseline) and ≥30 days post-index (follow-up). Patients were required to have ≥1 HIV diagnosis during baseline or follow-up. Those with only HIV prophylaxis were excluded. PLWoH were matched 2:1 to PLWH on demographic characteristics. Study outcomes were compared using z-tests with robust standard errors in an ordinary least squares regression or Rao–Scott tests. Results The study included 20,256 PLWH and 40,512 matched PLWoH, mean age 52 years. PLWH vs. PLWoH had higher mean (SD) Charlson comorbidity index scores (0.93 [1.59] vs. 0.61 [1.28]; p < .001) and a greater proportion had ≥1 comorbidity (69.1% vs. 54.5%, p < .001). The most prevalent comorbidities included hypertension (33.9% vs. 32.2%; p < .001), hyperlipidemia (29.4% vs. 24.6%; p < .001), chronic kidney disease (13.6% vs. 9.4%, p < .001), depression (13.1% vs. 7.3%, p < .001) and substance abuse (12.8% vs. 7.1%, p < .001). Mean (SD) non-ART prescription fills were higher among PLWH vs. PLWoH (11.9 [10.1] vs. 9.2 [9.4]; p < .001). Conclusions Multimorbidity and polypharmacy were more prevalent among PLWH vs. matched PLWoH. Findings support the need to consider comorbidities and comedications when choosing ART and to minimize drug–drug interactions and adverse events to improve patient outcomes.

Use of post-exposure prophylaxis for HIV in young people: an integrative review

Objective: to identify the use of post-exposure prophylaxis for HIV in young people in the context of sexual risk behavior. Methods: this is an integrative review, with search in LILACS, MEDLINE, CINAHL, SCOPUS, SciELO and COCHRANE, using the main descriptors: HIV, HIV Infections, Health Education, Technology and Post-Exposure Prophylaxis related through the Boolean operators AND and OR. Results: the final sample included 16 studies, mostly implemented with men who have sex with men. The articles were classified and analyzed from the categories: knowledge assessment; barriers/challenges to adherence to post-exposure prophylaxis; population using post-exposure prophylaxis; and educational technologies. Conclusion: non-adherence was related to the ignorance of basic information such as the indication of post-exposure prophylaxis, place of delivery, dosage, and side effects. Contributions to practice: synthesis of knowledge about the use of post-exposure prophylaxis by young people. In addition to increasing research on young people in the context of risky sexual behavior, especially in the nursing field, it subsidizes the development of health education strategies.

Evaluation of emergency department visits prior to an HIV diagnosis: Missed opportunities

ObjectiveThere is a high rate of occult infection and late diagnosis in HIV. Hospital emergency departments (ED) are an important point of health care. The present work aims to know the number of missed opportunities for HIV diagnosis occurring in the ED. MethodRetrospective multicenter cohort study that included all patients diagnosed with HIV infection in 2019 in 27 Spanish hospitals in 7 different autonomous communities. All ED consultation episodes in the 5 years prior to diagnosis were reviewed to find out the reason for consultation and whether this represented a missed opportunity for HIV diagnosis. ResultSeven hundred twenty-three patients were included, and 352 (48.7%, 95%CI: 45.1%–52.3%) had at least one ED visit during the 5 years prior to diagnosis (median 2, p25–p75: 1–4). One hundred and eighteen patients (16.3%, 95%CI: 13.8%–19.2%) had a missed diagnostic opportunity. The main consultations were drug use [145 (15%)], sexually transmitted infections [91 (9.4%)] and request for post-exposure HIV prophylaxis [39 (4%)]. One hundred and fifty-five (42.9%) of the 352 had less than 350 CD4/mm3 when the HIV diagnosis was established. In patients with previous ED visits, the mean time to diagnosis from this visit was 580 (SD 647) days. ConclusionsSixteen percent of patients diagnosed with HIV missed the opportunity to be diagnosed in the 5 years prior to diagnosis, highlighting the need to implement ED screening measures different from current ones to improve these outcomes.

High syphilis prevalence and incidence in people living with HIV and Preexposure Prophylaxis users: A retrospective review in the French Dat'AIDS cohort.

In the past years, we observed a sharp increase of Syphilis, especially among male who have sex with male (MSM), either HIV-infected, or on pre-exposure prophylaxis (PrEP). Our aim was to assess syphilis prevalence and incidence among people living with HIV (PLWH) and PrEP users. PLWH were included from 2010 to 2020 and PrEP users from 2016 to 2020 from the Dat'AIDS French cohort. We calculated syphilis prevalence and incidences for first infections, re-infections, and iterative infections (> 2 times). T-Tests, Wilcoxon tests and Chi2 test were used for descriptive analysis and multivariate logistic regression models were used to estimate Odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with syphilis. Among the 8 583 PLWH, prevalence of subject with past or present syphilis was 19.9%. These subjects were more likely MSM or transgender and aged over 35 years, but prevalence was lower in AIDS subjects. Same pattern was seen for incident infection and re-infection. Incidence was 3.8 per 100 person-years for infection and 6.5 per 100 person-years for re-infection. Among 1 680 PrEP users, syphilis prevalence was 25.8%, with an estimated 7.2% frequency of active syphilis. Risk of syphilis infection was higher in male and increased with age. Incidence was 11.2 per 100 person-years for infection and 11.1 per 100 person-years for re-infection. Syphilis prevalence and incidence were high, especially in older MSM with controlled HIV infection and PrEP users, enhancing the need to improve syphilis screening and behavioral risk reduction counseling among high-risk subjects.

Increases in human papillomavirus vaccine coverage over 12 months among a community-recruited cohort of gay, bisexual, and other men who have sex with men in Canada

BackgroundStarting in 2015/16, most Canadian provinces introduced publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) aged ≤ 26 years. We estimated 12-month changes in HPV vaccine coverage among community-recruited GBM from 2017 to 2021 and identified baseline factors associated with vaccine initiation (≥1 dose) or series completion (3 doses) among participants who were unvaccinated or partially vaccinated at baseline. MethodsWe recruited sexually-active GBM aged ≥ 16 years in Montreal, Toronto, and Vancouver, Canada, from 02/2017 to 08/2019 and followed them over a median of 12 months (interquartile range = 12–13 months). We calculated the proportion who initiated vaccination (≥1 dose) or completed the series (3 doses) by 12-month follow-up. Analyses were stratified by city and age-eligibility for the publicly-funded programs at baseline (≤26 years or > 26 years). We used multivariable logistic regression to identify baseline factors associated with self-reported incident vaccine initiation or series completion. ResultsAmong 165 unvaccinated participants aged ≤ 26 years at baseline, incident vaccine initiation (≥1 dose) during follow-up was 24.1% in Montreal, 33.3% in Toronto, and 38.9% in Vancouver. Among 1,059 unvaccinated participants aged > 26 years, incident vaccine initiation was 3.4%, 8.9%, and 10.9%, respectively. Higher education and trying to access pre-exposure prophylaxis for HIV were associated with incident vaccination among those aged ≤ 26 years, while younger age, residing in Vancouver (vs. Montreal), being diagnosed with anogenital warts, having both government and private extended medical insurance, and being vaccinated against influenza were associated with incident vaccination among those aged > 26 years. ConclusionsWe observed substantial gains in HPV vaccine coverage among young GBM within 5 + years of targeted program implementation, but gaps remain, particularly among older men who are ineligible for publicly-funded programs. Findings suggest the need for expanded public funding or insurance coverage for HPV vaccines.

Individual, Interpersonal, and Structural Factors That Influence Intentions to Use Pre-exposure Prophylaxis Among Sexual Minority Men in Miami.

Pre-exposure prophylaxis for HIV or "PrEP" holds great promise for reducing HIV incidence. However, in certain geographic settings, like Miami, a US HIV epicenter, uptake of PrEP has been paradoxically very low compared to other areas of the country. The goal of the current study was to examine factors associated with low uptake of PrEP in young sexual minority men in Miami. Qualitative data were extracted from conversations during voluntary HIV/STI counseling and testing sessions with 24 young sexual minority men, most of whom identified as racial/ethnic minorities. These sessions were completed as part of a baseline visit for a combined mental and sexual health intervention trial. Thematic analysis of transcripts revealed barriers and facilitators associated with PrEP uptake at multiple levels (individual, interpersonal, and economic and healthcare systems barriers). Individual-level themes included concerns about the safety of PrEP, risk compensation, and taking daily oral medication; and potential benefits of PrEP as a backup plan to condom use to reassure and reduce worry about HIV. Interpersonal-level themes included lack of knowledgeable and affirming medical providers, changing norms within the community around "safe sex," and PrEP use in serodiscordant partnerships. Economic and healthcare systems barriers included challenges to accessing PrEP because of a lack of insurance and high out-of-pocket cost. These data can be used to inform the development of interventions aligned withEnding the HIV Epidemicpriorities to increase PrEP use among young sexual minority men living in an HIV epicenter.

Pre-Exposure Prophylaxis for HIV (PrEP): Position Paper of the Catholic Medical Association.

Pre-Exposure Prophylaxis for HIV (PrEP): Position Paper of the Catholic Medical Association.

Awareness of post exposure prophylaxis for human immunodeficiency virus among healthcare professionals in a tertiary care hospital in Telangana, South India

Background: India has the third highest number of people living with human immunodeficiency virus (PLHIV) population in the world. Health care personnel (HCP) are major risk group for acquiring HIV infection by accidental occupational exposure. Knowledge on post-exposure prophylaxis (PEP) holds the key to prevent new HIV infections and also helps in reduction of anxiety among HCP in case of accidental exposure. This study was designed to assess the awareness of PEP and to compare the levels of knowledge among various cadres of HCP.Methods: A cross sectional study was conducted on awareness of PEP among the health care personnel of sample size 360 in a tertiary care centre in urban South India. Universal sampling was done and data was collected for a period of three months. Analysis was done using the Epi info 7.2.Results: Knowledge of PEP among HCP was found to be 63.57%. Knowledge of PEP among groups of faculties, post graduate (PG) students, interns, nurses and lab technicians was found to be 73.5%, 70.9%, 62.8%, 56.9% and 42.2% respectively. There was poor knowledge among the most vulnerable groups i.e. nurses and lab technicians who handle the blood samples of number of PLHIV on a given day. There was a felt need among the faculty, PGs and interns for a refresher training every year on advances in HIV prophylaxis and treatment.Conclusions: This study has brought to light the lacunae in awareness of PEP for HIV among HCP. As India has a high prevalence of HIV, and occupational exposure is pretty much inevitable, there is a pressing need to plug the gaps in awareness of PEP.

Health care providers\u2019 responses to sexually abused children and adolescents: a systematic review

BackgroundSexual abuse of children and adolescents is a significant health concern worldwide. Appropriate and timely health services for victims can prevent severe and long-term consequences. This study identified and categorized diagnostic and treatment services needed for sexually abused children and adolescents.MethodsSeveral databases, including MEDLINE, Web of Science, Scopus, Science Direct, ProQuest, and Google Scholar, were searched to retrieve studies on the topic and clinical guidelines in English covering the literature from 2010 to 2020 using search terms. Primary studies and guidelines were reviewed to identify treatment strategies and medical interventions related to sexually abused children and adolescents.ResultsTwenty-one studies and guidelines were selected and analyzed narratively. The quality of evidence was relatively good. We identified that effective health care systems for sexually abused children include the following: interview and obtain medical history, physical and anogenital examination, collecting forensic and DNA evidence, documenting all the findings, prevention and termination of pregnancy, diagnostic tests, prophylaxis for HIV and other STIs, vaccinations, and psychological intervention.ConclusionsThis review provides up-to-date evidence about adequate health care services for children and adolescent victims of sexual abuse. We conclude that recent studies have focused more on prophylaxis against HIV and other STIs, studies on vaccinating against HPV for victims are still limited, and future research in this area is needed.

Frequency of Injuries to Women after Sexual Offense - Relevance of a Gynecology Examination.

Introduction Up to a third of women worldwide report having experienced an act of sexual violence during their lifetime. The emergency gynecology department is often the first port of call for affected individuals. The aim of the current study was to evaluate the importance of gynecology examinations for women after a sexual offense and to evaluate the pattern of injuries sustained. Methods This study is a retrospective single center analysis of the gynecology and forensic examination reports of all women examined for a suspected sexual offense in the central emergency department of a university hospital between 2013 and 2017 (n = 692). We evaluated genital and extragenital injury patterns, age, offender profile, time of offense, and substance use, as well as the administration of post-coital contraception and post-exposure prophylaxis for HIV. Results The affected individuals had a mean age of 26 (12 – 91 years). Almost 75% of affected individuals presented within 24 hours of the reported sexual offense. Extragenital injuries were detected in 78.6% of patients and genital injuries in 28.5%. Overall, 20.1% of the women reported complete memory loss and 18.7% partial memory loss of the actual event. Risk factors for memory lapse were the consumption of alcohol and/or the (possibly non-consensual) administration of other substances acting on the central nervous system. A history of alcohol consumption by the victim (hazard ratio [HR] 1.95; 95% confidence interval [CI] 1.21 – 3.12, p = 0.006) and younger victims aged between 25 – 49 years (HR 1.75; 95% CI 1.07 – 2.85, p = 0.025) were associated with the occurrence of extragenital injuries. However, if the perpetrator was someone who was known to the affected individual, fewer extragenital injuries were sustained (HR 0.60; 95% CI 0.36 – 0.99, p = 0.046). Reports of genital injuries, associated with an older age of affected individuals and indications of anal penetration, resulted in more frequent administration of post-exposure prophylaxis (29.1% vs. 19.5%, p < 0.012) and hepatitis B (active) vaccination (40% vs. 28.5%, p < 0.028). Conclusion Emergency gynecology examinations form a fundamental component of the medical care and the assessment of affected women after a sexual offense, since almost a third of victims sustain injuries to the genital region. In addition to a detailed complete physical examination and expert forensic documentation of physical and genital injuries, victims should also be offered psychological support which is easy for them to access.

Real-world safety of pre-exposure prophylaxis for HIV.

In the decade since it was first approved, tenofovir-based pre-exposure prophylaxis (PrEP) has emerged as one of the most effective means of preventing the spread of HIV.1,2 However, PrEP remains underused3 and PrEP users tend to disengage from care over time.4 There are many potential barriers to PrEP use in real-world settings, including associated costs to patients and clinics, the need for frequent follow up, and concerns about potential side-effects. Addressing these barriers might make PrEP more accessible to people at risk for HIV transmission as we work towards ending the HIV epidemic.

The impact of COVID-19 lockdown on men having sex with men (MSM)

ABSTRACT Social distancing including lockdowns are acceptable measures to cope with the COVID-19 pandemic. In this cross sectional study, we surveyed the impact of these measurements on sexual behavior and pre-exposure prophylaxis for HIV (PrEP) use among MSM. A digital questionnaire was distributed via social media and geographically based meeting applications after the first lockdown (March–April 2020). 1194 MSM responded, 91.8% were HIV negative, 19.4% of them used PrEP regularly, and 8.2% were people living with HIV (PLWH). Median age was 34.5 years. 54.4% reported that they kept strictly social distancing guidelines. Low education, hazardous sexual behavior, moderate/severe, and depression predicted low compliance with social distancing guidelines. 66.7% reported a significant decrease in the number of casual sex partners. 55% of those who took PrEP reduced their PrEP intake. Many of the PLWH and PrEP users reduced their medical follow-up. In light of the continuous outbreak and the risk of further outbreaks in the future consideration should be given to provide continuing access to HIV and sexual health clinics.

Women Trust Their OBGYNs to Provide Preexposure Prophylaxis: An Opportunity for HIV Prevention.

ObjectiveThe objective of this study was to understand how women perceive the role of their Obstetrician and Gynecologist (OBGYN) in screening for and providing preexposure prophylaxis (PrEP) for HIV prevention.MethodsWe recruited women ages 18–45 years receiving obstetric or gynecological care at an academic medical center in the Bronx, NY. Thirty participants were enrolled: 10 seeking care for family planning, 10 seeking prenatal care, and 10 seeking care for a sexually transmitted infection. We screened participants for HIV acquisition risk using a PrEP screening tool. We conducted face-to-face, semi-structured interviews, which were audio-recorded, transcribed, and entered into Dedoose for analysis of themes using a grounded theory approach.ResultsSixty percent of the participants were Latinx and 33% African American. Seventy percent had one or more risk factors for HIV acquisition based on the PrEP screening tool, indicating they would benefit from a PrEP discussion. Three main themes emerged from the analysis of interview data. Participants viewed OBGYNs as experts in sexual and reproductive healthcare and believed they were experts in PrEP. Participants were concerned about “PrEP stigma”, being judged by their clinicians as being sexually promiscuous if they expressed a need for PrEP. Lastly, when participants trusted their OBGYN, that trust became a facilitator for women to consider PrEP and offset stigma as a barrier to identifying patients who are candidates for PrEP.ConclusionWomen established in care with an OBGYN are enthusiastic about having access to PrEP services incorporated into their sexual and reproductive healthcare. A universal approach to HIV prevention would avert stigma surrounding HIV care and prevention.

3. Impact of Parent-Adolescent Relationship Quality and Sexual Health Communication on Parental Willingness to Support Adolescent Use of Pre-Exposure Prophylaxis for HIV: Lessons for Post-Pandemic Sexual Health Interventions

Pre-exposure prophylaxis (PrEP) is a safe and highly effective method of HIV prevention, yet PrEP use among US adolescents at risk for HIV has been low. Sexual health communication between parents and adolescents has been shown to decrease teen pregnancy and increase condom use, but data are scarce on the impact of communication on PrEP use. We wanted to understand parents’ perspectives on PrEP and the role of parent-adolescent relationship quality and sexual health communication on parents’ willingness to support their adolescent using PrEP (“PrEP willingness”), to inform post-pandemic interventions to improve PrEP uptake among adolescents at risk for HIV.