Acceptability and Barriers to Pre-Exposure Prophylaxis (PrEP) in Atlanta’s Adolescents and their Parents

Background: Adolescents aged 13-24 years account for 23% of new HIV infections in Atlanta. However, data on HIV prevention strategies in this population is lacking. Use of pre-exposure prophylaxis (PrEP) in adults has shown good acceptability and risk reduction of HIV by up to 92%. This study aims to understand the acceptability of and barriers to PrEP in adolescents and their parents.

Methods: We administered validated PrEP acceptability and barriers measures to HIV(-) 13-17 year olds from January-April 2016 in an adolescent clinic and emergency department in Atlanta, GA. Total measure scores (acceptability = AS; barriers = BS) were calculated by averaging survey items and ranged from 1 to 3. For AS, 1 was very unlikely, while 3 was very likely to accept PrEP; concomitantly, scores near 3 indicated fewer barriers to PrEP. Participants were stratified by risk group (high versus low), high risk being: more than three lifetime partners, unprotected sex, use of alcohol or drugs before sex, and lack of consistent and correct condom use. Two-sample testing and Pearson correlations were used to evaluate between groups.

Results: 102 adolescent/parent dyads were recruited. Adolescents were 67% female, 94% black, with mean age of 15.7 ± 1.5 years. Overall, 17% met high risk criteria. Thirty one percent admitted having sex, of those, 53% used condoms routinely. Three percent had a previous sexually transmitted illness, but none were aware of their HIV status. Overall AS averaged between somewhat to very likely (2.4 ± 0.5) with no differences between risk groups (p=0.571). BS averaged between unlikely and somewhat likely (2.0 ± 0.4) with no differences between risk groups (p=0.180).

Parents were 94% female, 96% black, with mean age of 42.5 ± 8.9 years. Nearly all (93%) had conversations about sex with their teenagers, and 23% knew their child was sexually active. Overall parent AS averaged between somewhat likely and very likely (2.2 ± 0.6), and BS averaged between unlikely and somewhat likely (1.9 ± 0.5) with no difference between risk groups (p=0.276 and p=0.333).

Conclusion: The adolescent/parent dyad are likely to accept PrEP and its implementation as an HIV prevention method, regardless of risk. These results support future PrEP research in adolescents.