Weighing the Options: Which PrEP (Pre-exposure Prophylaxis) Modality Attributes Influence Choice for Young Gay and Bisexual Men in the United States?

AIDS Behav. 2024 Sep;28(9):2970-2978. doi: 10.1007/s10461-024-04384-1. Epub 2024 Aug 10.

Abstract

Pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission, but uptake and adherence among young men who have sex with men (YMSM) remains suboptimal. New PrEP formulations may enhance PrEP use, but little is known about their acceptability. We enrolled 39 cis- and transgender YMSM (age 18-34) from Boston, MA; Jackson, MS; Birmingham, AL; and New Orleans, LA, who participated in video-based focus groups (n = 30) or in-depth interviews (n = 9) to examine how new PrEP products (e.g., injections, monthly pills, implants) are perceived and might be improved for YMSM. Focus groups were transcribed, coded, and analyzed using grounded theory and content analysis. Nearly half (46%) of participants were Black; 11% identified as Hispanic. Seventy-nine percent were PrEP experienced. Product preference was driven by the desire for flexible, safe, effective, and affordable PrEP options. A majority of participants preferred subcutaneous injections every 6 months or monthly pills dispersed in 3 or 4 doses. Subcutaneous injections and batched monthly pills were favored by those with demanding schedules and those who desired fewer provider visits; monthly pills were more appealing for those who feared needles. Despite broad preferences for longer-acting products for convenience, participants raised concerns regarding side effects and waning protection after missed doses. Participants felt that more education about safety and efficacy profiles of new products could influence their attitudes. These findings suggest that it is important to prioritize YMSM's dynamic lifestyles during product development, and that product safety and efficacy information should be accessible in youth-friendly language.

Keywords: HIV; Long-Acting PrEP; Next Generation PrEP; PrEP; Product Preference; YMSM.

MeSH terms

  • Adolescent
  • Adult
  • Anti-HIV Agents* / administration & dosage
  • Bisexuality
  • Choice Behavior
  • Focus Groups*
  • HIV Infections* / prevention & control
  • Homosexuality, Male* / psychology
  • Homosexuality, Male* / statistics & numerical data
  • Humans
  • Interviews as Topic
  • Male
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data
  • Pre-Exposure Prophylaxis*
  • Qualitative Research
  • Sexual and Gender Minorities* / psychology
  • United States
  • Young Adult

Substances

  • Anti-HIV Agents