Experiences of Successful PrEP Uptake Among Adolescent Sexual Minority Men in the United States: A Qualitative Exploration.

Male adolescent sexual minorities are at elevated risk of HIV acquisition yet demonstrate low rates of PrEP uptake. Understanding the experiences of adolescents who have successfully accessed PrEP may inform ways to best support adolescents seeking PrEP. Adolescent sexual minorities (N = 100) who reported utilizing PrEP responded to open-ended items asking about their initial PrEP experiences and advice for others. Qualitative analysis suggested that adolescents' ability to access PrEP is influenced by managing parental involvement and seeking culturally competent health care providers. Additionally, they reported how the benefits and drawbacks of taking PrEP played a role in their PrEP use. Findings suggest that educational PrEP interventions targeted at this population could improve uptake by incorporating discussions on side effects and mental health benefits associated with PrEP use. Structural interventions are warranted that improve adolescents' ability to seek sexual health care independently and make room for parental involvement when adolescents could benefit from their support.

Acceptability of 'Humpr': An Online Tool to Educate Adolescent Sexual Minority Males About Sexual Networking Applications.

We examined the acceptability of Humpr - an interactive, online tool developed to educate adolescent sexual minority males (ASMM) about how to safely navigate sexual networking applications (SNA). We developed Humpr as part of a larger HIV intervention trial in the U.S. In Humpr, 218 ASMM aged 14-20 (Mage = 17.18) created a mock dating profile, explored simulated user profiles, learned health-related information (e.g. slang indicating HIV/STI risks and/or drug use intentions), and then gave feedback regarding acceptability of the tool. Results showed that Humpr was very well-received, with 94% overall approval rates. Reasons for liking Humpr were evenly split between liking it for educational and entertaining reasons. Participants praised Humpr for its realistic design and interactive interface that allowed them to engage and connect with the tool. The majority (61%) had used SNAs in the past, but many still reported learning something new from Humpr. Participants also appreciated the acknowledgment of SNA use in ASMM and how the education was implemented in an open and judgment-free way. Topics learned from Humpr included how to be safe on SNAs and warning signs for HIV/STI risks. Suggested areas of improvement included having an opt-out option for those who do not wish to participate for any reason (e.g. discomfort) and additional educational content (e.g. consequences of being a minor on SNAs). Taken together, the findings offer preliminary evidence for the potential educational benefits of digital tools like Humpr for ASMM with and without prior SNA exposure.

Top, Bottom, and Versatile Orientations among Adolescent Sexual Minority Men.

Sexual role preference or self-label (i.e., top, versatile, or bottom) has been well studied in samples of sexual minority men (SMM) but lacks research among adolescent sexual minority men (ASMM). In response, data were collected from 302 ASMM (15-18 years old), measuring sexual self-label, relationship and sexual experience, sexually explicit media use, use of geosocial networking applications, penis size satisfaction, and gender atypicality. Results showed there was no significant difference in the distribution of sexual position self-identity in ASMM when compared with data from published, adult samples. A model that associated sexual socialization factors with adopting any self-label was significant, with greater number of partners, previous geosocial networking app use, and more relationship experience being positive predictors of having a label. Additionally, a model that tested the convergent validity between self-label and enacted sexual behaviors was significant. Both receptive and insertive sex enactments were highly correlated with corresponding labels. Lastly, gender atypicality and penis size satisfaction were significant predictors of sexual position self-identity. Data from our study supports sexual self-labeling occurring before adulthood, during adolescence for SMM. Furthermore, it shows that socialization factors (e.g., partner frequency, using apps) are important in the development of sexual position self-identity in this population.

The PrEP Cascade in a National Cohort of Adolescent Men Who Have Sex With Men.

BACKGROUND: Pre-exposure prophylaxis (PrEP) has been an available biomedical intervention for at-risk adolescents for over 2 years; however, progression from awareness to uptake and adherence has been slow. In response, we map adolescent men who have sex with men (AMSM) onto the PrEP Motivation Cascade to identify stages for intervention. METHODS: We analyzed PrEP-related attitudinal and behavioral data from a US national cohort of 1398 AMSM. RESULTS: A majority of the sample (53.9%) were identified as appropriate PrEP candidates. Of those identified as appropriate candidates, 51.8% were precontemplative (stage 1; unwilling to take or believing they were inappropriate candidates for PrEP), and 48.2% reached contemplation (stage 2; willing and self-identified as appropriate candidates). Only 16.3% of candidates reached preparation (stage 3; seeing PrEP as accessible and planning to initiate PrEP), and 3.1% reached PrEP action (stage 4; prescribed PrEP). Although few of the AMSM identified as appropriate candidates were on PrEP, most users (87%) reported high adherence to 4+ doses per week (stage 5; PrEP maintenance). Factors associated with reaching later stages were being older, being out to parents, and engaging in previous HIV/sexually transmitted infection testing. CONCLUSIONS: AMSM PrEP use falls short of recommended levels. PrEP campaigns are needed to raise awareness by targeting key AMSM subgroups that underestimate the appropriateness of use. Equally important, parents and health providers of AMSM should serve educational roles to help facilitate potential PrEP uptake, by motivating adolescents and giving them the skills needed to request, fill, and adhere to a prescription.