(PS7-A20) Patterns of Prep Adherence, "Breaks," and Discontinuation Among a Racially/ethnically Diverse Sample of Urban Young Sexual Minority Men

Background

            Despite near perfect effectiveness at preventing HIV acquisition through sex, uptake of daily oral Pre-exposure Prophylaxis (PrEP) remains low among non-white young men who have sex with men, ages 18-29 (YMSM). Given that such YMSM are at markedly increased risk of HIV infection, recent work has sought to understand barriers and facilitators to PrEP uptake; however, patterns of adherence and discontinuation among YMSM remain understudied. Given that most sexual minority men will not take PrEP for their entire lives, and because suboptimal adherence may open opportunities for HIV infection, it is important to better understand YMSM PrEP use beyond initiation. Moreover, PrEP has been shown to make sex more satisfactory and pleasurable by decreasing anxiety around HIV-acquisition in some YMSM.

Aims

             This research aims to characterize PrEP use patterns—adherence, non-adherence (e.g., taking PrEP “vacations”), and discontinuation—among an urban sample of racially/ethnically diverse YMSM. We prioritize an intersectional approach, as systems of social inequality likely impact the PrEP use behaviors of non-white YMSM.

Method

            111 YMSM completed daily-diary surveys for 90 days, self-reporting whether they took their daily oral PrEP on the prior day. Preliminary analyses of the data classified overall adherence (i.e., overall adherent, non-adherent/PrEP breaks taken, discontinued). Patterns were then examined alongside demographic variables.

Results

            Of the total sample, 22 stopped responding to diaries before study end; this was more common among Hispanic/Latin participants and those employed full-time (vs part- or unemployed). PrEP was more often discontinued by Black, multi-racial, or full-time employed YMSM; it was never reported by bisexual YMSM. Breaks or non-adherence were more commonly reported by younger, bisexual, or part-time employed participants. Fully adherent participants were mostly non-Hispanic, white YMSM who identified as gay and were older (i.e., ≥ 24.98 y/o). Analyses of changes in adherence over time (i.e., every 30 days vs overall) and of comparison of self-reported against biomedical data are ongoing and will be presented pending acceptance. These data will help quantify the level of HIV risk to which YMSM may be exposed during self-reported PrEP stoppages or discontinuation.   

Discussion     

            This research suggests that non-white, younger YMSM may be less PrEP-adherent (and thus more exposed to HIV infection). Such vulnerabilities are likely tied to structural barriers such as limited financial resources, un(der)employment, and the like. Such barriers are supported by the literature on PrEP uptake, but less is known about how YMSM arrive at decisions to take breaks from or discontinue PrEP altogether. Understanding such experiences will allow clinicians to tailor educational and PrEP access programs that meet the needs of all YMSM who deserve safe, satisfying sex, both of which PrEP imparts.