Skip to main content

Advertisement

SpringerLink
Log in

Preferences for Injectable PrEP Among Young U.S. Cisgender Men and Transgender Women and Men Who Have Sex with Men

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Young men who have sex with men account for approximately 20% of incident HIV infections in the U.S. Antiretroviral pre-exposure prophylaxis (PrEP) administered as a daily pill has been shown to decrease HIV acquisition in at-risk individuals. New modalities for PrEP are being developed and tested, including injectable PrEP; however, acceptability of these emerging modalities has not yet been examined in youth. We conducted six focus groups with 36 young men and transgender men and women who have sex with men in Boston, Chicago, and Los Angeles in 2016 to assess interest in and preference for different PrEP modalities. Youth were purposively recruited based on diversity of age, race/ethnicity, and prior PrEP experience. Data were coded using content coding based on key domains of the interview guide, in particular around the central themes of interest in and barriers and facilitators to injectable PrEP use. Participants were knowledgeable about oral PrEP but suggested barriers to broader uptake, including stigma, marginalization, and access to information. While participants were split on preference for injectable versus oral PrEP, they agreed quarterly injections may be more manageable and better for those who have adherence difficulties and for those who engage in sex more frequently. Concerns specific to injectable PrEP included: severity/duration of side effects, pain, level of protection prior to next injection, distrust of medical system and injections, and cost. Understanding barriers to and preferences for diverse prevention modalities will allow for more HIV prevention options, improved products, and better interventions, thus allowing individuals to make informed HIV prevention choices.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Arnett, J. J. (2004). Emerging adulthood: The winding road from late teens through the twenties. New York, NY: Oxford University Press.

    Google Scholar 

  • Berkowitz, S. (1997). Analyzing qualitative data. In J. Frechtling & L. Sharp (Eds.), The user-friendly handbook for mixed-method evaluations (Chap. 4). National Science Foundation. Retrieved September 13, 2017 from https://www.nsf.gov/pubs/1997/nsf97153/chap_4.htm.

  • Bogart, L. M., & Thorburn, S. (2005). Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans? Journal of Acquired Immune Deficiency Syndromes, 38, 213–218.

    Article  PubMed  Google Scholar 

  • Cáceres, C. F., O’Reilly, K. R., Mayer, K. H., & Baggaley, R. (2015). PrEP implementation: Moving from trials to policy and practice. Journal of the International AIDS Society, 18, 20222. doi:10.7448/IAS.18.4.20222.

    PubMed  PubMed Central  Google Scholar 

  • Carlsen, B., & Glenton, C. (2011). What about N? A methodological study of sample-size reporting in focus group studies. BMC Medical Research Methodology, 11, 26. doi:10.1186/1471-2288-11-26.

    Article  PubMed  PubMed Central  Google Scholar 

  • Centers for Disease Control and Prevention. (2016). HIV surveillance report: Diagnoses of HIV infection in the United States and dependent areas, 2015. Retrieved from https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdf.

  • Chen, J. Y., Fox, S. A., Cantrell, C. H., Stockdale, S. E., & Kagawa-Singer, M. (2007). Health disparities and prevention: Racial/ethnic barriers to flu vaccinations. Journal of Community Health, 32, 5–20. doi:10.1007/s10900-006-9031-7.

    Article  PubMed  Google Scholar 

  • DeCuir-Gunby, J. T., Marshall, P. L., & McCulloch, A. W. (2011). Developing and using a codebook for the analysis of interview data: An example from a professional development research project. Field Methods, 23, 136–155.

    Article  Google Scholar 

  • Fisher, J. A., & Kalbaugh, C. A. (2011). Challenging assumptions about minority participation in US clinical research. American Journal of Public Health, 101, 2217–2222.

    Article  PubMed  PubMed Central  Google Scholar 

  • Freeman, R., Gwadz, M. V., Silverman, E., Kutnick, A., Leonard, N. R., Ritchie, A. S., … Martinez, B. Y. (2017). Critical race theory as a tool for understanding poor engagement along the HIV care continuum among African American/Black and Hispanic persons living with HIV in the United States: A qualitative exploration. International Journal for Equity in Health, 16, 54. doi:10.1186/s12939-017-0549-3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gamble, V. N. (1997). Under the shadow of Tuskegee: African Americans and health care. American Journal of Public Health, 87, 1773–1778.

    Article  PubMed  PubMed Central  Google Scholar 

  • Golub, S. A., Gamarel, K. E., Rendina, H. J., Surace, A., & Lelutiu-Weinberger, C. L. (2013). From efficacy to effectiveness: Facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care and STDs, 27, 248–254.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gomez, A. M., Fuentes, L., & Allina, A. (2014). Women or LARC first? Reproductive autonomy and the promotion of long-acting reversible contraceptive methods. Perspectives on Sexual and Reproductive Health, 46, 171.

    Article  PubMed  PubMed Central  Google Scholar 

  • Grant, R. M., Anderson, P. L., McMahan, V., Liu, A., Amico, K. R., Mehrotra, M., … Glidden, D. V. (2014). Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: A cohort study. Lancet Infectious Diseases, 14, 820–829.

    Article  PubMed  Google Scholar 

  • Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., … Glidden, D. V. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363, 2587–2599.

    Article  PubMed  Google Scholar 

  • Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18, 59–82. doi:10.1177/1525822X05279903.

    Article  Google Scholar 

  • Hair, B. G. (2015). Preexposure prophylaxis-related stigma: Strategies to improve uptake and adherence—A narrative review. HIV/AIDS-Research and Palliative Care, 7, 241. doi:10.2147/HIV.S72419.

    Article  Google Scholar 

  • Hergenrather, K. C., Emmanuel, D., Durant, S., & Rhodes, S. D. (2016). Enhancing HIV prevention among young men who have sex with men: A systematic review of HIV behavioral interventions for young gay and bisexual men. AIDS Education and Prevention, 28, 252–271.

    Article  PubMed  Google Scholar 

  • Herron, P. D. (2016). Ethical implications of social stigma associated with the promotion and use of pre-exposure prophylaxis for HIV prevention. LGBT Health, 3, 103–108. doi:10.1089/lgbt.2014.0114.

    Article  PubMed  Google Scholar 

  • Hosek, S., Celum, C., Wilson, C. M., Kapgiannis, B., Delany-Moretlwe, S., & Bekker, L. G. (2016). Preventing HIV among adolescents with oral PrEP: Observations and challenges in the United States and South Africa. Journal of the International AIDS Society, 19, 21107. doi:10.7448/IAS.19.7.21107.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hosek, S. G., Rudy, B., Landovitz, R., Kapogiannis, B., Siberry, G., Rutledge, B., … Wilson, C. M. (2017). An HIV preexposure prophylaxis demonstration project and safety study for young MSM. Journal of Acquired Immune Deficiency Syndromes, 74, 21–29.

    Article  PubMed  Google Scholar 

  • Johnson, J. C. (1990). Selecting ethnographic informants. Newbury Park, CA: Sage.

    Google Scholar 

  • Krakower, D. S., Mimiaga, M. J., Rosenberger, J. G., Novak, D. S., Mitty, J. A., White, J. M., & Mayer, K. H. (2012). Limited awareness and low immediate uptake of pre-exposure prophylaxis among men who have sex with men using an internet social networking site. PLoS ONE, 7, e33119. doi:10.1371/journal.pone.0033119.

    Article  PubMed  PubMed Central  Google Scholar 

  • Krueger, R. A., & Casey, M. A. (2014). Focus groups: A practical guide for applied research. Thousand Oaks, CA: Sage.

    Google Scholar 

  • Markowitz, M., Frank, I., Grant, R., Mayer, K. H., Margolis, D. A., Hudson, K. J., … Spreen, W. (2016). ECLAIR: Phase 2A Safety and PK study of Cabotegravir LA in HIV-uninfected men. Presented at the Conference on Retroviruses and Opportunistic Infections, Boston, MA.

  • Mayer, K. H., Biello, K. B., Novak, D. S., Krakower, D., & Mimiaga, M.J. (2017). PrEP uptake disparities in a diverse online sample of U.S. men who have sex with men. Presented at the Conference on Retroviruses and Opportunistic Infections, Seattle, WA.

  • McCormack, S., Dunn, D. T., Desai, M., Dolling, D. I., Gafos, M., Gilson, R., … Gill, O. N. (2015). Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): Effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet, 387, 53–60.

    Article  PubMed  Google Scholar 

  • Meyers, K., & Golub, S. (2015). Planning ahead for implementation of long-acting HIV prevention: Challenges and opportunities. Current Opinion in HIV/AIDS, 10, 290–295.

    Article  Google Scholar 

  • Meyers, K., Rodriguez, K., Moeller, R. W., Gratch, I., Markowitz, M., & Halkitis, P. N. (2014). High interest in a long-acting injectable formulation of pre-exposure prophylaxis for HIV in young men who have sex with men in NYC: A P18 cohort substudy. PLoS ONE, 9, e114700.

    Article  PubMed  PubMed Central  Google Scholar 

  • Milena, Z. R., Dainora, G., & Alin, S. (2008). Qualitative research methods: A comparison between focus-group and in-depth interview. Annals of the University of Oradea, Economic Science Series, 17, 1279–1283.

    Google Scholar 

  • Molina, J. M., Capitant, C., Spire, B., Pialoux, G., Cotte, L., Charreau, I., … Delfraissy, J. F. (2015). On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. New England Journal of Medicine, 373, 2237–2246. doi:10.1056/NEJMoa1011205.

    Article  PubMed  Google Scholar 

  • Moutsiakis, D. L., & Chin, P. N. (2007). Why Blacks do not take part in HIV vaccine trials. Journal of the National Medical Association, 99, 254–257.

    PubMed  PubMed Central  Google Scholar 

  • O’Neil, M. E., Peipert, J. F., Zhao, Q., Madden, T., & Secura, G. (2013). Twenty-four-month continuation of reversible contraception. Obstetrics and Gynecology, 122, 1083. doi:10.1097/AOG.0b013e3182a91f45.

    Article  PubMed Central  Google Scholar 

  • Parsons, J. T., Rendina, H. J., Whitfield, T. H., & Grov, C. (2016). Familiarity with and preferences for oral and long-acting injectable HIV pre-exposure prophylaxis (PrEP) in a national sample of gay and bisexual men in the US. AIDS and Behavior, 20, 1390–1399.

    Article  PubMed  PubMed Central  Google Scholar 

  • Patton, M. Q. (2005). Qualitative research. In B. S. Everitt & D. Howell (Eds.), Encyclopedia of statistics in behavioral science. Hoboken, NJ: Wiley. doi:10.1002/0470013192.bsa514.

    Google Scholar 

  • Peipert, J. F., Madden, T., Allsworth, J. E., & Secura, G. M. (2012). Preventing unintended pregnancies by providing no-cost contraception. Obstetrics and Gynecology, 120, 1291–1297.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ryan, G. W., & Bernard, H. R. (2003). Techniques to identify themes. Field Methods, 15, 85–109.

    Article  Google Scholar 

  • Sengupta, S., Strauss, R. P., DeVellis, R., Quinn, S. C., DeVellis, B., & Ware, W. B. (2000). Factors affecting African-American participation in AIDS research. Journal of Acquired Immune Deficiency Syndrome, 24, 275–284.

    Article  Google Scholar 

  • Shui, I. M., Weintraub, E. S., & Gust, D. A. (2006). Parents concerned about vaccine safety: Differences in race/ethnicity and attitudes. American Journal of Preventive Medicine, 31, 244–251. doi:10.1016/j.amepre.2006.04.006.

    Article  PubMed  Google Scholar 

  • Suite, D. H., La Bril, R., Primm, A., & Harrison-Ross, P. (2007). Beyond misdiagnosis, misunderstanding and mistrust: Relevance of the historical perspective in the medical and mental health treatment of people of color. Journal of the National Medical Association, 99, 879.

    PubMed  PubMed Central  Google Scholar 

  • US Public Health Service. (2014). Preexposure prophylaxis for the prevention of HIV infection in the United States—2014: A clinical practice guideline. Atlanta, GA: Center for Disease Control.

    Google Scholar 

  • Usinger, K. M., Gola, S. B., Weis, M., & Smaldone, A. (2016). Intrauterine contraception continuation in adolescents and young women: A systematic review. Journal of Pediatric and Adolescent Gynecology, 29, 659–667. doi:10.1016/j.jpag.2016.06.007.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by Viiv Healthcare, Inc. Additional support for Dr. Mayer’s role was provided by the Harvard University Center for AIDS Research (CFAR), an NIH Funded Program (P30 AI060354), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, NIDDK, NIGMS, NIMHD, FIC, and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02912, USA

    Katie B. Biello & Matthew J. Mimiaga

  2. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA

    Katie B. Biello & Matthew J. Mimiaga

  3. The Fenway Institute, Fenway Health, Boston, MA, USA

    Katie B. Biello, Morgan T. Drucker, Matthew J. Mimiaga, Elliot Marrow, Julia Coffey-Esquivel & Kenneth H. Mayer

  4. Center for Health Equity Research, Brown University, Providence, RI, USA

    Katie B. Biello & Matthew J. Mimiaga

  5. Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA

    Sybil Hosek & Jennifer Brothers

  6. Division of Adolescent Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Marvin Belzer

  7. Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Kenneth H. Mayer

  8. Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA

    Kenneth H. Mayer

Authors
  1. Katie B. Biello
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sybil Hosek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Morgan T. Drucker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marvin Belzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthew J. Mimiaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elliot Marrow
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Julia Coffey-Esquivel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jennifer Brothers
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kenneth H. Mayer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katie B. Biello.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Biello, K.B., Hosek, S., Drucker, M.T. et al. Preferences for Injectable PrEP Among Young U.S. Cisgender Men and Transgender Women and Men Who Have Sex with Men. Arch Sex Behav 47, 2101–2107 (2018). https://doi.org/10.1007/s10508-017-1049-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-017-1049-7

Keywords

Search

Navigation