Background: Emerging adult men who have sex with men (EAMSM; ages 18-25) could benefit greatly from PrEP given their disproportionate burden of HIV in the U.S, yet their PrEP adoption remains far lower than their older counterparts. Prior research has been limited in identifying factors that distinguish EAMSM who have adopted PrEP and those who have not. The objectives of this study were to describe EAMSM''s engagement along the PrEP continuum; calculate the proportion of PrEP-indicated (high HIV risk) participants currently not taking PrEP; and identify social/behavioral correlates of PrEP use.
Methods: Participants (N=236), recruited via Facebook and Grindr (2018-2019), completed a web-survey assessing PrEP use and risk behaviors. Eligibility included self-reported HIV-negative, cis-gender MSM aged 18-25, who reported sex with men in the past 6 months, and resided in Mid-Atlantic urban metro areas. Descriptive statistics were generated for participants'' PrEP-related outcomes. Prior STI diagnoses, condomless anal intercourse, and drug use before/during anal intercourse were dichotomized, respectively, and summed to reflect participants'' PrEP indications. Multivariable logistic regressions assessed differences in PrEP use by indications, psychosocial factors (e.g., perceived susceptibility), and sociodemographic characteristics (e.g., age, race).
Results: Most EAMSM (n=222, 94.1%) were aware of PrEP. Among PrEP-aware participants, 62.6% never used PrEP, 9.0% discontinued PrEP, and 28.4% were currently on PrEP. Among EAMSM who had never used PrEP, 78.4% had >1 PrEP indication, 41% indicated high PrEP willingness, and 27.3% intended to seek PrEP within 3 months. In multivariable models, PrEP use was associated with older age (AOR=1.36, 95% CI: 1.06, 1.74), number of PrEP indications (AOR=1.98; 95% CI: 1.26-3.09), and recent drug use (AOR=2.26; 95% CI: 1.02-5.02). EAMSM were less likely to use PrEP if they were in a relationship (AOR=0.39, 95% CI: 0.18, 0.85), or reported higher perceived susceptibility to HIV (AOR=0.52; 95% CI: 0.35, 0.78).
Conclusions: Consistent with national trends, PrEP use among EAMSM in our sample was low despite meeting PrEP indication/eligibility. Our findings advocate for scaled-up PrEP campaigns that focus on EAMSM, especially those in non-monogamous relationships, highlighting how PrEP can reduce their HIV susceptibility. These efforts must be paired with multilevel strategies that minimize barriers to PrEP access/adoption.