Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun;74(6):1112-1117.
doi: 10.1016/j.jadohealth.2024.02.028. Epub 2024 Apr 6.

Discordance Between HIV Risk Perception, Sexual Behavior, and Pre-exposure Prophylaxis Adherence Among Young Sexual and Gender Minorities in the United States

Nicole K Kelly  1 , Matthew T Rosso  2 , Crissi Rainer  2 , Kristina Claude  2 , Kathryn E Muessig  2 , Lisa Hightow-Weidman  2
Affiliations

Discordance Between HIV Risk Perception, Sexual Behavior, and Pre-exposure Prophylaxis Adherence Among Young Sexual and Gender Minorities in the United States

Nicole K Kelly et al. J Adolesc Health. 2024 Jun.

Abstract

Purpose: In the United States, youth experience suboptimal HIV pre-exposure prophylaxis (PrEP) adherence. One common idea posits that this is due to their developing decision-making skills. However, quantitative evidence of this assumption is limited. We therefore examined whether individual decision-making factors, such as HIV risk perception and sexual behavior, predicted PrEP adherence in a national trial of young sexual and gender minorities (YSGMs).

Methods: In 2019-2021, the Adolescent Medicine Trials Network for HIV Interventions 142 study enrolled 225 PrEP users (ages 16-24) throughout the country. Regression models estimated the associations between HIV risk perception (using a modified Perceived HIV Risk Scale), sexual behavior (condomless anal sex in ≤ 3 months), and self-reported oral PrEP adherence (≥4 pills in the past week) at the same time point (baseline) and longitudinally (3 months).

Results: Baseline risk perception (risk ratio [RR]: 0.92, 95% confidence interval [CI]: 0.82, 1.04) and condomless anal sex (RR: 1.10, 95% CI: 0.97, 1.25) were not associated with PrEP adherence at the same time point and did not predict 3-month adherence (RR: 0.97, 95% CI: 0.85, 1.11; RR: 1.05, 95% CI: 0.93, 1.19, respectively). Baseline risk perception was not associated with condomless anal sex at either time point (baseline RR: 1.16, 95% CI: 0.94, 1.43; 3-month RR: 1.07, 95% CI: 0.90, 1.28).

Discussion: In this national trial of YSGM, HIV risk perception and condomless anal sex did not predict PrEP adherence. Targeting individual-level perceptions and behaviors will likely insufficiently address youth's suboptimal PrEP use. Future research should identify YSGM-specific adherence drivers and train providers to recognize such motivations.

Keywords: Adherence; HIV pre-exposure prophylaxis; HIV prevention; Risk perception; Young sexual and gender minorities.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: The authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Directed acyclic graph depicting the hypothesized relationships between HIV risk perception, sexual behavior, and pre-exposure prophylaxis (PrEP) adherence among young sexual and gender minorities *As a proxy for ethno-racism
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention. Prevent HIV: Ending the HIV Epidemic. Available at: https://www.cdc.gov/endhiv/prevent.html. AccessedMarch 29, 2023.
    1. Centers for Disease Control and Prevention. Ending the HIV Epidemic in the U.S. (EHE). Available at: https://www.cdc.gov/endhiv/index.html. AccessedMarch 29, 2023.
    1. Spinner CD, Boesecke C, Zink A, et al. HIV pre-exposure prophylaxis (PrEP): a review of current knowledge of oral systemic HIV PrEP in humans. Infection 2016;44:151–8. - PubMed
    1. Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2020. HIV Surveillance Supplemental Report; 2022.
    1. Sullivan PS, Johnson AS, Pembleton ES, et al. Epidemiology of HIV in the USA: epidemic burden, inequities, contexts, and responses. The Lancet 2021;397:1095–106. - PMC - PubMed

Substances