Abstract
Preexposure prophylaxis (PrEP) has tremendous potential to decrease new HIV infections among populations at high risk, such as men who have sex with men (MSM). That potential is already becoming realized among adult MSM, where PrEP uptake has increased rapidly in the past several years. However, expanding PrEP access to adolescent MSM (AMSM) will be more challenging. This commentary reviews the existing scientific literature relevant to PrEP use for AMSM and highlights critical areas in need of further attention before PrEP is likely to impact the HIV epidemic among adolescents. We highlight concerns that need to be addressed in the areas of (1) achieving adequate coverage of PrEP in the adolescent population, (2) increasing awareness and access, (3) supporting adherence and maintenance, and (4) ensuring that PrEP does not perpetuate existing disparities. Across all of these domains, we highlight the central roles of parents and healthcare providers in supporting AMSM PrEP utilization. Finally, we suggest a number of areas of future research that must be addressed before PrEP is likely to see wide implementation among AMSM.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Balaji, A. B., An, Q., Smith, J. C., Newcomb, M. E., Mustanski, B., Prachand, N. G., … Paz-Bailey, G. (2018). High human immunodeficiency virus incidence and prevalence and associated factors among adolescent sexual minority males-3 cities, 2015. Clinical Infectious Diseases,66(6), 936–944. https://doi.org/10.1093/cid/cix902.
Centers for Disease Control and Prevention. (2017). Compendium of evidence-based interventions and best practices for HIV prevention. Retrieved September 7, 2018 from https://www.cdc.gov/hiv/research/interventionresearch/compendium/index.html.
Centers for Disease Control and Prevention. (2018). HIV among youth. Retrieved September 7, 2018 from https://www.cdc.gov/hiv/group/age/youth/index.html.
Chenault, K., Waddell, J., & Tepper, V. (2018). Pediatric providers and HIV pre-exposure prophylaxis. Pediatrics. https://doi.org/10.1542/peds.141.1_meetingabstract.247.
Culp, L. A., & Caucci, L. (2013). State adolescent consent laws and implications for HIV pre-exposure prophylaxis. American Journal of Preventive Medicine,44(1), S119–S124. https://doi.org/10.1016/j.amepre.2012.09.044.
Curran, G. M., Bauer, M., Mittman, B., Pyne, J. M., & Stetler, C. (2012). Effectiveness-implementation hybrid designs: Combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical Care,50(3), 217–226. https://doi.org/10.1097/MLR.0b013e3182408812.
Dashiff, C., Hardeman, T., & McLain, R. (2008). Parent-adolescent communication and diabetes: An integrative review. Journal of Advanced Nursing,62(2), 140–162. https://doi.org/10.1111/j.1365-2648.2007.04549.x.
Fisher, C. B., Fried, A. L., Macapagal, K., & Mustanski, B. (2018). Patient-provider communication barriers and facilitators to HIV and STI preventive services for adolescent MSM. AIDS and Behavior, 22, 3417–3428. https://doi.org/10.1007/s10461-018-2081-x.
Fishman, J., Taylor, L., & Frank, I. (2016). Awareness of HPV and uptake of vaccination in a high-risk population. Pediatrics,138(2), e20152048. https://doi.org/10.1542/peds.2015-2048.
Gilead. (2018). Advancing access co-pay support. Retrieved September 7, 2018 from https://www.gileadadvancingaccess.com/financial-support/gilead-copay-card.
Goodreau, S. M., Hamilton, D. T., Jenness, S. M., Sullivan, P. S., Valencia, R. K., Wang, L. Y., … Rosenberg, E. S. (2018). Targeting human immunodeficiency virus pre-exposure prophylaxis to adolescent sexual minority males in higher prevalence areas of the United States: A modeling study. Journal of Adolescent Health,62(3), 311–319. https://doi.org/10.1016/j.jadohealth.2017.09.023.
Hamilton, D. T., Rosenberg, E. S., Jenness, S. M., Sullivan, P. S., Wang, L. Y., Dunville, R. L., … Goodreau, S. M. (2019). Modeling the joint effects of adolescent and adult PrEP for sexual minority males in the United States. PLoS ONE, 14(5), e0217315.
Hart-Cooper, G. D., Allen, I., Irwin, C. E., Jr., & Scott, H. (2018). Adolescent health providers’ willingness to prescribe pre-exposure prophylaxis (PrEP) to youth at risk of HIV infection in the United States. Journal of Adolescent Health,63(2), 242–244. https://doi.org/10.1016/j.jadohealth.2018.03.016.
Holloway, I. W., Dougherty, R., Gildner, J., Beougher, S. C., Pulsipher, C., Montoya, J. A., … Leibowitz, A. (2017). Brief report: PrEP uptake, adherence, and discontinuation among California YMSM using geosocial networking applications. Journal of Acquired Immune Deficiency Syndromes,74(1), 15–20. https://doi.org/10.1097/qai.0000000000001164.
Hosek, S. G., Landovitz, R. J., Kapogiannis, B., Siberry, G. K., Rudy, B., Rutledge, B., … Wilson, C. M. (2017). Safety and feasibility of antiretroviral preexposure prophylaxis for adolescent men who have sex with men aged 15 to 17 years in the United States. JAMA Pediatrics,171(11), 1063–1071. https://doi.org/10.1001/jamapediatrics.2017.2007.
Itriyeva, K. (2018). Use of long-acting reversible contraception (LARC) and the Depo-Provera shot in Adolescents. Current Problems in Pediatric and Adolescent Health Care,48(12), 321–332. https://doi.org/10.1016/j.cppeds.2018.11.002.
Landovitz, R. J., Kofron, R., & McCauley, M. (2016). The promise and pitfalls of long-acting injectable agents for HIV prevention. Current Opinion in HIV and AIDS,11(1), 122–128. https://doi.org/10.1097/coh.0000000000000219.
Luk, J. W., Gilman, S. E., Haynie, D. L., & Simons-Morton, B. G. (2017). Sexual orientation differences in adolescent health care access and health-promoting physician advice. Journal of Adolescent Health,61(5), 555–561. https://doi.org/10.1016/j.jadohealth.2017.05.032.
Morgan, E., Moran, K., Ryan, D. T., Mustanski, B., & Newcomb, M. E. (2018a). Threefold increase in PrEP uptake over time with high adherence among young men who have sex with men in Chicago. AIDS and Behavior, 22, 3637–3644. https://doi.org/10.1007/s10461-018-2122-5.
Morgan, E., Ryan, D. T., Newcomb, M. E., & Mustanski, B. (2018b). High rate of discontinuation may diminish PrEP coverage among young men who have sex with men. AIDS and Behavior, 22, 3645–3648. https://doi.org/10.1007/s10461-018-2125-2.
Mustanski, B., & Fisher, C. B. (2016). HIV rates are increasing in gay/bisexual teens: IRB barriers to research must be resolved to bend the curve. American Journal of Preventive Medicine,51(2), 249–252. https://doi.org/10.1016/j.amepre.2016.02.026.
Mustanski, B., Greene, G. J., Ryan, D., & Whitton, S. W. (2015). Feasibility, acceptability, and initial efficacy of an online sexual health promotion program for LGBT youth: The Queer Sex Ed intervention. Journal of Sex Research,52(2), 220–230. https://doi.org/10.1080/00224499.2013.867924.
Mustanski, B., Macapagal, K., Thomann, M., Feinstein, B. A., Newcomb, M. E., Motley, D., & Fisher, C. B. (2018a). Parents’ perspectives about adolescent boys’ involvement in biomedical HIV prevention research. Archives of Sexual Behavior,47(7), 1923–1935. https://doi.org/10.1007/s10508-017-1035-0.
Mustanski, B., Newcomb, M. E., & Clerkin, E. M. (2011). Relationship characteristics and sexual risk-taking in young men who have sex with men. Health Psychology,30(5), 597–605. https://doi.org/10.1037/a0023858.
Mustanski, B., Parsons, J. T., Sullivan, P. S., Madkins, K., Rosenberg, E., & Swann, G. (2018b). Biomedical and behavioral outcomes of keep it up!: An ehealth HIV prevention program RCT. American Journal of Preventive Medicine,55(2), 151–158. https://doi.org/10.1016/j.amepre.2018.04.026.
Newcomb, M. E., Ryan, D. T., Garofalo, R., & Mustanski, B. (2014). The effects of sexual partnership and relationship characteristics on three sexual risk variables in young men who have sex with men. Archives of Sexual Behavior,43(1), 61–72. https://doi.org/10.1007/s10508-013-0207-9.
Ocfemia, M. C. B., Dunville, R., Zhang, T., Barrios, L. C., & Oster, A. M. (2018). HIV diagnoses among persons aged 13–29 years—United States, 2010–2014. Morbidity and Mortality Weekly Report,67(7), 212–215. https://doi.org/10.15585/mmwr.mm6707a2.
Odeny, T. A., Padian, N., Doherty, M. C., Baral, S., Beyrer, C., Ford, N., & Geng, E. H. (2015). Definitions of implementation science in HIV/AIDS. Lancet HIV,2(5), e178–e180. https://doi.org/10.1016/S2352-3018(15)00061-2.
Patel, H., Jeve, Y. B., Sherman, S. M., & Moss, E. L. (2016). Knowledge of human papillomavirus and the human papillomavirus vaccine in European adolescents: A systematic review. Sexually Transmitted Infections,92(6), 474–479. https://doi.org/10.1136/sextrans-2015-052341.
Phillips, G., II, Ybarra, M. L., Prescott, T. L., Parsons, J. T., & Mustanski, B. (2015). Low rates of human immunodeficiency virus testing among adolescent gay, bisexual, and queer men. Journal of Adolescent Health,57(4), 407–412. https://doi.org/10.1016/j.jadohealth.2015.06.014.
Rolle, C. P., Rosenberg, E. S., Siegler, A. J., Sanchez, T. H., Luisi, N., Weiss, K., … Kelley, C. F. (2017). Challenges in translating PrEP interest into uptake in an observational study of young black MSM. Journal of Acquired Immune Deficiency Syndromes,76(3), 250–258. https://doi.org/10.1097/qai.0000000000001497.
Spinner, C. D., Boesecke, C., Zink, A., Jessen, H., Stellbrink, H. J., Rockstroh, J. K., & Esser, S. (2016). HIV pre-exposure prophylaxis (PrEP): A review of current knowledge of oral systemic HIV PrEP in humans. Infection,44(2), 151–158. https://doi.org/10.1007/s15010-015-0850-2.
Thoma, B. C., & Huebner, D. M. (2018). HIV pre-exposure prophylaxis engagement among adolescent men who have sex with men: The role of parent-adolescent communication about sex. Journal of Acquired Immune Deficiency Syndromes,79(4), 453–457. https://doi.org/10.1097/QAI.0000000000001837.
US Public Health Service. (2017). Preexposure prophylaxis for the prevention of HIV infection in the United States—2017 update. Retrieved from Atlanta, GA.
Whitfield, T. H. F., John, S. A., Rendina, H. J., Grov, C., & Parsons, J. T. (2018). Why I quit pre-exposure prophylaxis (PrEP)? A mixed-method study exploring reasons for PrEP discontinuation and potential re-initiation among gay and bisexual men. AIDS and Behavior, 22, 3566–3575. https://doi.org/10.1007/s10461-018-2045-1.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Huebner, D.M., Mustanski, B. Navigating the Long Road Forward for Maximizing PrEP Impact Among Adolescent Men Who Have Sex with Men. Arch Sex Behav 49, 211–216 (2020). https://doi.org/10.1007/s10508-019-1454-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-019-1454-1