"I had condomless sex, but I'm calm because I use PrEP": Experiences of adolescent's men who have sex with men and transgender women with daily oral PrEP in Brazil

BACKGROUND: Data on experiences of daily oral pre-exposure prophylaxis (PrEP) use among adolescent key populations (AKP) of men who have sex with men (MSM) and transgender women (TGW) have shown that adherence to PrEP and its continuation is still a challenge. We aimed to analyze individual and social experiences related to the use of PrEP among AKP participants of the PrEP1519 Study.
METHODS: PrEP1519 is the first PrEP demonstration cohort study, among AKP aged 15-19 y.o., ongoing in 3 Brazilian cities. Twenty semi-structured interviews were conducted, between June 2019 to June 2020 (17 MSM, 3 TGW), during their PrEP follow-up visit. Interviews were transcribed, coded and a thematic analysis was performed on NVivo software.
RESULTS: The experiences related to the daily use of PrEP have highlighted the positive role of health service, such as friendly LGBTQI+ environment, young health team, accessible location, cash reimbursement to pay for lunch and transportation, and peer navigators to support adherence to PrEP and specific needs (eg hormone therapy doubts and listening family''s problems). But individual and social issues related to the use of PrEP in the beginning were also noticed: pill size, handling of missed doses, lack of experience with sustained medication use, and possible mild side effects. Besides, most of them reported the need to hide the PrEP pills from family and friends, in order to avoid stigmatization because it could be seen as a symbol of 'promiscuity' or as a sign of a non-heteronormative sexual orientation, and also to avoid suspicions about being infected with HIV. Nevertheless, these barriers did not prevent PrEP continuation. TGW reported initial concerns about possible interactions between PrEP and hormone therapy. The occurrence of missed doses was minimized by the use of an alarm clock and combined intake time for PrEP and hormone pills.
CONCLUSIONS: Friendly and non-judgmental environment were central to the positive experiences of daily PrEP use. It evidenced to be effective for PrEP retention and adherence as well. Fear of stigmatization and difficulty in sustaining a disciplined intake practice of daily PrEP pointed to the need for permanent support for AKP users of PrEP.