Introduction
Methods
Participants and Procedures
Survey Measures and Interview Guide Questions
Quantitative Data Analysis
Qualitative Data Analysis
Results
Quantitative Survey
Qualitative Interviews
Demographic characteristics | Survey (N = 37) | Interview (N = 18) |
---|---|---|
Age, mean years (SD) | 23.9 (3.3) | 22.6 (2.3) |
Sex at birth, N (%) | ||
Male | 35 (94.6) | 16 (88.9) |
Female | 2 (5.4) | 2 (11.1) |
Gender identity, N (%) | ||
Cisgender man | 30 (81.1) | 12 (66.7) |
Genderqueer | 5 (13.5) | 4 (22.2) |
Transgender woman | 1 (2.7) | 1 (5.6) |
Transgender man | 1 (2.7) | 1 (5.6) |
Race/ethnicity, N (%) | ||
White non-Latinx | 14 (37.8) | 4 (22.2) |
Hispanic/Latinx | 11 (29.7) | 7 (38.9) |
Asian non-Latinx | 5 (13.5) | 4 (22.2) |
Multiracial or another ethnicity non-Latinx | 5 (13.5) | 2 (11.1) |
Black/African American non-Latinx | 2 (5.4) | 1 (5.6) |
Sexual orientation, N (%) | ||
Gay | 27 (73.0) | 12 (66.7) |
Queer | 5 (13.5) | 3 (16.7) |
Bisexual | 4 (10.8) | 2 (11.1) |
Straight | 1 (2.7) | 1 (5.6) |
Work, N (%) | ||
Working | 20 (54.1) | 9 (50.0) |
Student | 10 (27.0) | 5 (27.8) |
Unemployed | 6 (16.2) | 3 (16.7) |
On leave/disability | 1 (2.7) | 1 (5.6) |
Education, N (%) | ||
High school graduate | 5 (13.5) | 3 (16.7) |
Some college | 13 (35.1) | 8 (44.4) |
Bachelor’s degree | 9 (24.3) | 5 (27.8) |
Some postgraduate education | 3 (8.1) | 0 (0) |
Postgraduate degree | 7 (18.9) | 2 (11.1) |
Financial situation, N (%) | ||
I cannot get by on the money I have | 4 (10.8) | 4 (22.2) |
I can barely get by on the money I have | 15 (40.5) | 5 (27.8) |
I have enough money to live comfortably | 17 (46.0) | 9 (50.0) |
Prefer not to answer | 1 (2.7) | 0 (0.0) |
Living situation, N (%) | ||
Own house/apartment/room | 19 (51.4) | 9 (50.0) |
Parent’s house/apartment | 15 (40.5) | 7 (38.9) |
Welfare hotel, month-to-month hotel, treatment facility | 3 (8.1) | 2 (11.1) |
California region, N (%) | ||
San Francisco Bay Area | 26 (70.3) | 13 (72.1) |
Los Angeles | 5 (13.5) | 3 (16.7) |
Sacramento/San Joaquin | 2 (5.4) | 1 (5.6) |
Prefer not to answer | 4 (10.8) | 1 (5.6) |
Impact of SIP on Sex and Dating
Interviewees discussed an ongoing discomfort with sharing their PrEP use with friends and family due to self-perceived stigma related to feeling like a “philanderer.” In the survey, 35% of participants reported feeling worried about people thinking they were living with HIV if they were seen taking PrEP.It was bittersweet [to be home]. However, it is difficult because at least for me, being queer, certain aspects of myself I did have to ‘tame’ down coming back home and I think now it’s kind of for my own safety and being what is palatable for them.- 23-year-old Queer Latinx Genderqueer
Impact of SIP on PrEP Access and Use
I discontinued it [PrEP] because I wasn’t being active, and it was months and months of not being active. I was taking it for the first month because no one was really sure how long the pandemic was going to be, so I was taking it for the sake of not messing up my routine. Once I noticed things were progressively not getting better, I stopped taking it.- 22-year-old Queer Latinx Genderqueer
PrEP care and preferences | Total (N = 37) |
---|---|
Current PrEP use, N (%) | |
Daily oral | 28 (75.7) |
2-1-1 | 5 (13.5) |
Recently discontinued | 4 (10.8) |
Reasons for 2-1-1 PrEP usea, N (%) | |
Infrequent sex | 3 (60.0) |
Change in sexual partners | 1 (20.0) |
Fewer side effects | 1 (20.0) |
Reasons stopped PrEPb,c, N (%) | |
Trouble accessing PrEP care/refills | 3 (75.0) |
Reduced sexual encounters | 3 (75.0) |
Change in sexual partners | 2 (50.0) |
Lack of provider knowledge about PrEP | 1 (25.0) |
Provider advised to stop | 1 (25.0) |
Setting of PrEP care, before SIPc, N (%) | |
In-person clinic | 26 (70.3) |
Virtual/telephone clinic | 5 (13.5) |
School/college clinic | 4 (10.8) |
Not on PrEP before pandemic | 4 (10.8) |
Pharmacy | 1 (2.7) |
Setting of PrEP care, during SIPc, N (%) | |
Virtual/telephone clinic | 22 (59.5) |
In-person clinic | 21 (56.8) |
Pharmacy | 4 (10.8) |
Did not get PrEP care during SIP | 3 (8.1) |
School/college clinic | 1 (2.7) |
Top preference for PrEP care setting, N (%) | |
In-person clinic | 16 (43.2) |
Virtual/telephone visit | 14 (37.8) |
Pharmacy | 3 (8.1) |
Mobile van | 1 (2.7) |
School/college clinic | 1 (2.7) |
Prefer not to answer | 2 (5.4) |
Challenges with taking PrEP, during SIPc, N (%) | |
Healthcare access | 22 (59.5) |
Difficulty receiving refills | 11 (29.7) |
Inability going to lab for testing | 10 (27.0) |
Lack of available clinic appointments | 8 (21.6) |
Lack of communication with provider | 6 (16.2) |
Uncertainty about taking PrEP if having less sex | 19 (51.4) |
Missing doses due to changes in daily routine | 10 (27.0) |
Did not experience challenges | 5 (13.5) |
Decreased privacy during SIP | 2 (5.4) |
Difficulty getting HIV test, during SIP, N (%) | |
Easy to very easy | 16 (43.2) |
Neither easy nor difficult | 8 (21.6) |
Difficult to very difficult | 11 (29.7) |
I did not attempt to get an HIV test | 2 (5.4) |
Concern that others will think you are living with HIV while taking PrEP, N (%) | |
Slightly to extremely worried | 13 (35.1) |
Not worried | 24 (64.9) |
Change in number of sexual partners during SIP, N (%) | |
Reduced | 19 (51.4) |
Unchanged | 5 (13.5) |
Increased | 13 (35.1) |
Sexual partners per month before pandemic, mean (SD) | 4.2 (8.1) |
Sexual partners per month during pandemic, mean (SD) | 3.1 (8.2) |
Perceptions on How to Improve PrEP Care
There was high interest in alternative PrEP formulations, particularly injectable PrEP, and alternative dosing strategies of oral PrEP (Fig. 1). Results from the survey demonstrated that all participants were interested in an injection every 6 months with 92% either very or extremely interested followed by once-monthly oral pills (89%) and an injection every 2 months (70%). These options were followed by a hypothetical option of daily oral gummies (61%) and an existing option of daily oral PrEP (49%).I was nervous to find a provider and talk about PrEP until on Grindr I saw a notification about free accessible PrEP, and it was virtual, which I thought was so much better for me. I don’t really like to go in person and risk someone seeing me... Also, I was still on my parent’s insurance, and I was nervous...but [my providers] do a lot of their stuff through government assistance, which I thought was so nice because I didn’t have to think about copays or anything like that... Honestly if I didn’t find them, I don’t think I would have re-engaged with PrEP probably for a while.- 24-year-old gay Asian male
Theme | Interviewee characteristics | Quote |
---|---|---|
Improve provider ability to recommend, discuss, and manage PrEP care | 23-year-old gay Latino male | My normal PCP…I realized he was not well versed in anything that had to do with gay culture… He was a nice guy, he just didn’t know much about PrEP. I had to tell him what it was, and he just gave me a prescription without knowing what I had to do next |
24-year-old gay Asian male | It [PrEP] is brought up in a negative sense, like ‘Oh you’re engaging in risky behaviors,’ which is a wrong way to go about bringing up PrEP… When I think of providers, I think they just see us as numbers or as risk behaviors that they have to come and save us. But I think it’s more like trying to engage with us. Talk more besides the quantity of partners, what we’re engaging in when it comes to sex. Getting to know us more than what is on paper. I know it’s hard because providers are so busy and they have more patients to see, but those small things can completely change how people interpret providers | |
Improve race equity in PrEP care and sexual health | 23-year-old gay Latino male | Putting more diversity in these healthcare positions, programs that get more minorities into healthcare. More minority doctors, more minority nurses and EMTs. The more diversity you have in those positions is the best and most effective way to help the disparities within the community itself |
22-year-old queer Latinx genderqueer | I’ve seen an ad that was in regard to PrEP and PrEP usage. It was a round table of queer people talking about their experiences with PrEP. That really helped me and made me feel more comfortable. Specifically, also seeing other people of color talking about PrEP… I feel like seeing how that would be accessible to people within my community or other communities like mine would help, especially with young people | |
Improve public knowledge about PrEP | 24-year-old gay Asian male | I asked my teacher about men having sex with men, and she completely shut me down right then and there. Me as a sixth grader… I clearly remember that because I felt disgusting in the fact that I thought about men having sex with men, and so I internalized that problem within myself for even asking that question…A lot of programs in the country are still very abstinence only approach to sex education… We need to provide more comprehensive sex education to not have my experience where teachers bring down the idea that it was brought up. We just need to have it talked about so youth don’t have a question of uncertainty. Not only in HIV and queer topics, but sex education needs to transition from risky behaviors and STIs into more positive topics about what a healthy relationship is and how to properly engage in safe sex rather than just ‘Don’t have sex!’ |
21-year-old queer Latinx transmasculine | Being a trans person on PrEP and not being a transwoman, I feel like a minority… When I see advertisements for it, the kind of person I am isn’t considered as someone who would need it. I feel a little bit embarrassed like ‘Am I really the target audience? Am I really supposed to be taking it?’ Because I never see anyone like me | |
22-year-old straight White transfeminine | It [PrEP] literally should be everywhere and not just in the queer community…You don’t flip through Cosmopolitan and see an ad for PrEP, but you’ll see an ad for Trojan condoms or spermicide or lube. It’s kind of a stigma that only people in the queer community have these issues and need this medication |