PrEP Uptake & Youth
In 2015, the Food and Drug Administration (FDA) approved Truvada, a HIV antiretroviral medication, as preexposure prophylaxis (PrEP) against HIV transmission among adults, expanding it to adolescents in 2018. Taken orally once a day, PrEP has been shown to reduce the risk of HIV transmission from sex by 99% when taken as prescribed. In 2019, there were 36,801 new HIV diagnoses in the United States. Of these, about 21% of diagnoses (7,734) occurred among adolescents and young adults aged 12 to 24 years, with Black and Latinx youth disproportionately representing 77 to 82% of new infections in these populations. While well positioned to help reduce the incidence of HIV among many populations, uptake of oral Truvada as PrEP remains very low, especially among adolescents and young adults.
Up to 10% of adults at risk for HIV have been prescribed PrEP. In contrast, only 1.5% of adolescents younger than 18 years in the same category are receiving PrEP. Several factors contribute to the poor uptake of PrEP among adolescents and young adults, such as awareness, cost, and access.
A survey of adolescents demonstrated that two-third of adolescents were unaware of the existence of PrEP and 90% of those eligible for PrEP reported never being informed by their healthcare provider. In another study, over 50% of sampled adolescents mentioned access and affordability as a barrier to considering PrEP. Although many adults face many of the same barriers, adolescents and young adults often depend on their parents for health insurance, financial resources, and transportation, sometimes where the question of whether or not one should start PrEP can mean disclosing their sexual orientation or sexual behavior to parents.
Next Generation PrEP Products
One strategy to improve PrEP uptake among young adults is to offer different modalities, or new ways of taking the medication, beyond a daily oral regiment. These new modalities are often referred to as “next-generation PrEP products.”
Presently, researchers are studying a variety of new options including as-needed oral dosing, injectables, implants, and more cutting-edge technologies like monoclonal antibodies. (To learn more about these products, visit By offering more options, people would be able to choose the PrEP product that speaks to their unique needs, such as:
- Behavioral patterns (e.g. daily routine, sexual behaviors)
- Social and cultural factors (e.g. maintaining privacy to avoid HIV/LGBTQ+ stigma)
- Long or short-term use of PrEP
However, it is important for researchers, healthcare practitioners, and other stakeholders to better understand young adults’ perspectives on next-generation PrEP products. As many products begin to be evaluated for FDA approval, it will be fundamental to make sure that accompanying marketing, education, and clinical practices are made with youths’ attitudes, understanding, and needs in mind.
NextChoices & Exploring Youth Perspectives of Next Generation PrEP Products
To address this, researchers at X interviewed X YMSM to explore attitudes, experiences, and preferences of young men who have sex with men (YMSM) regarding HIV prevention and healthcare experiences. In addition, the same researchers also recruited a subset of participants to evaluate descriptions of PrEP products for clarity, appropriateness, and suggestions for improvement. The goal of this research is to explore the many factors that might influence the uptake of next-generation PrEP products.
Below is a graphic summarizing some of the key findings and recommendations from the studies.
 CDC. (2019). Preventing New HIV Infections. Center for Disease Control and Prevention.
 CDC. (2021). PrEP Effectiveness. Center for Disease Control and Prevention.
 CDC. (2019). HIV Surveillance Report: Diagnoses of HIV Infection in the United States and Dependent Areas 2019. Center for Disease Control.
 Siegler, A.J., Mouhanna, F., Giler, R.M., et al. (2017). The Prevalence of Pre-Exposure Prophylaxis Use and the Pre-Exposure Prophylaxis-to-Need Ratio in the Fourth Quarter of the 2017. Annual Epidemiology, 28(12).
 Moskowitz, D. A., Moran, K. O., Matson, M., Alvarado-Avila, A., & Mustanski, B. (2021). The PrEP Cascade in a National Cohort of Adolescent Men Who Have Sex with Men. Journal of Acquired Immune Deficiency Syndromes. 86(5).
 Santos, R.P., Adams, M.E., Lepow, M., & Tristam, D. (2018). Adolescents’ knowledge and acceptance of pre-exposure prophylaxis (PrEP) in the Capital District region of New York. Open Forum of Infectious Disease
 Macapagal, K., Kraus, A., Korpak, A.K. et al. (2020). PrEP Awareness, Uptake, Barriers, and Correlates Among Adolescents Assigned Male at Birth Who Have Sex with Males in the U.S.. Archive of Sexual Behavior, 39.