Discordance Between HIV Risk Perception, Sexual Behavior, and Pre-exposure Prophylaxis Adherence Among Young Sexual and Gender Minorities in the United States

Purpose: In the United States, youth experience suboptimal HIV pre -exposure prophylaxis (PrEP) adherence. One common idea posits that this is due to their developing decision -making skills. However, quantitative evidence of this assumption is limited. We therefore examined whether individual decision -making factors, such as HIV risk perception and sexual behavior, predicted PrEP adherence in a national trial of young sexual and gender minorities (YSGMs). Methods: In 2019-2021, the Adolescent Medicine Trials Network for HIV Interventions 142 study enrolled 225 PrEP users (ages 16-24) throughout the country. Regression models estimated the associations between HIV risk perception (using a modified Perceived HIV Risk Scale), sexual behavior (condomless anal sex in < 3 months), and self -reported oral PrEP adherence (>= 4 pills in the past week) at the same time point (baseline) and longitudinally (3 months). Results: Baseline risk perception (risk ratio [RR]: 0.92, 95% confidence interval [CI]: 0.82, 1.04) and condomless anal sex (RR: 1.10, 95% CI: 0.97, 1.25) were not associated with PrEP adherence at the same time point and did not predict 3 -month adherence (RR: 0.97, 95% CI: 0.85, 1.11; RR: 1.05, 95% CI: 0.93, 1.19, respectively). Baseline risk perception was not associated with condomless anal sex at either time point (baseline RR: 1.16, 95% CI: 0.94, 1.43; 3 -month RR: 1.07, 95% CI: 0.90, 1.28). Discussion: In this national trial of YSGM, HIV risk perception and condomless anal sex did not predict PrEP adherence. Targeting individual -level perceptions and behaviors will likely insuffi- ciently address youth's suboptimal PrEP use. Future research should identify YSGM-specific adherence drivers and train providers to recognize such motivations. (c) 2024 Society for Adolescent Health and Medicine. All rights reserved.