Background
Adolescence and young adulthood are stages of life that often encompass sexual debut, sexual exploration, and sexual experimentation.[1] When these periods intersect with activities such as substance use or decreased condom use, youth become increasingly prone to HIV acquisition.[1] In 2021, individuals aged 13 to 24 years of age accounted for roughly 1 in 5 persons who newly acquired HIV in the United States.[2] Sexual, gender and racial/ethnic minority youth, particularly those living in the Southern United States, are even more vulnerable to acquiring HIV. In this context, HIV preexposure prophylaxis (PrEP) is a known, effective, data-proven biomedical tool for HIV prevention.[3] In 2012, tenofovir DF-emtricitabine (TDF-FTC) was approved by the US Food and Drug Administration (FDA) for HIV PrEP in adults, but there was little initial uptake among young adults. In 2018, the FDA changed the criteria for HIV PrEP in youth to be based on weight, with approval for those weighing at least 35 kg (77 lb).[3]
HIV PrEP Coverage for Youth
In the United States, HIV PrEP has been underused as an HIV prevention tool in adolescents and young adults (Figure 1).[4] In 2022, only about 24% of youth 16-24 years of age who had an indication for PrEP actually received HIV PrEP (the percentage of people receiving HIV PrEP versus those with an HIV PrEP indication is often referred to as “PrEP coverage”).[4] Several studies have demonstrated barriers in the HIV PrEP care cascade for adolescents, including lack of HIV PrEP awareness among adolescents or their guardians, reluctance to use HIV PrEP, and reduced HIV PrEP prescriptions written by clinicians for adolescents who have a significant risk of acquiring HIV.[5,6] These studies underscore the importance of a multipronged approach to addressing deficits in the HIV PrEP care cascade—from awareness to prescribing to uptake to adherence, in order to successfully harness HIV PrEP to advance the goal of ending the HIV epidemic in the United States. Further, several issues continue to exist related to health professionals that contribute to low HIV PrEP prescribing for youth, including lack of knowledge, hesitancy to prescribe, and inability to effectively conduct sexual history discussions with youth.