{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T20:14:08Z","timestamp":1762460048905,"version":"3.41.2"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T00:00:00Z","timestamp":1638835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005192","name":"California HIV\/AIDS Research Program","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005192","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p><jats:bold>Introduction:<\/jats:bold> HIV pre-exposure prophylaxis (PrEP) in the form of a daily oral medication is highly effective at preventing HIV. In the United States, awareness about PrEP has steadily increased over time among individuals vulnerable to HIV, however awareness has not translated into widescale uptake. Estimates are that fewer than 20% of 1.2 million Americans for whom PrEP is indicated are utilizing it. We sought to understand how individuals moved from PrEP awareness to PrEP utilization.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> We conducted a series (<jats:italic>n<\/jats:italic> = 31) of in-depth interviews with young people, predominantly gay and bisexual men, ages 18\u201329 years old between February 2015 and January 2016, as part of the evaluation of a multi-year demonstration project funded to test innovative approaches to improve sexual health outcomes and curb the HIV epidemic in California. Interviews were audio-recorded and transcribed verbatim. We conducted a thematic analysis.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> We present a continuum of PrEP awareness that spans three phases\u2014basic, moderate and advanced. Participants rarely reported becoming well-informed about PrEP over the course of an initial exposure to PrEP information. Learning occurred after multiple exposures to PrEP information through numerous intersecting forms, messengers and formal and informal communication channels. Positively framed messages delivered by formal messengers emphasizing PrEP as a sensible HIV prevention strategy and explicitly communicating a regard for sexual wellness were overwhelmingly persuasive and facilitated movement to the advanced awareness phase. Once participants reached the advanced phase of PrEP awareness, uptake was possible.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Our analysis provides insights into how PrEP awareness led to PrEP uptake among young gay and bi-sexual men. Building demand among those in the basic awareness phase took longer than those in the moderate phase. Individuals involved in formal and informal PrEP education can set reasonable expectations about whether, when and how eventual uptake may occur when keeping the continuum of PrEP awareness framework in mind. Many young, gay and bi-sexual male prospective PrEP users will benefit from positively framed messages that emphasize personal well-being, including social, sexual and emotional benefits of PrEP use.<\/jats:p>","DOI":"10.3389\/fpubh.2021.677716","type":"journal-article","created":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T09:44:33Z","timestamp":1638870273000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Exploring the Shift From HIV Pre-exposure Prophylaxis Awareness to Uptake Among Young Gay and Bisexual Men"],"prefix":"10.3389","volume":"9","author":[{"given":"Kimberly A.","family":"Koester","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xavier A.","family":"Erguera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ifeoma","family":"Udoh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mi-Suk","family":"Kang Dufour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey H.","family":"Burack","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet J.","family":"Myers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,7]]},"reference":[{"key":"B1","unstructured":"Global HIV & AIDS Statistics \u2014 Fact Sheet2020"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e809","DOI":"10.1016\/S2352-3018(19)30230-9","article-title":"The global burden of HIV and prospects for control","volume":"6","author":"Pandey","year":"2019","journal-title":"Lancet HIV."},{"key":"B3","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1097\/QAI.0000000000002051","article-title":"Adherence to PrEP among young men who have sex with men participating in a sexual health services demonstration project in Alameda County, California","volume":"81","author":"Myers","year":"2019","journal-title":"J Acquir Immune Defic Syndr"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/2325958220919269","article-title":"\u201cA Good Habit\u201d: telehealth PrEP Users find benefit in quarterly monitoring requirements","volume":"19","author":"Koester","year":"2020","journal-title":"J Int Assoc Provid AIDS Care."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1960","DOI":"10.2105\/AJPH.2015.302816","article-title":"How stigma surrounding the use of HIV preexposure prophylaxis undermines prevention and pleasure: a call to destigmatize \u201ctruvada whores","volume":"105","author":"Calabrese","year":"2015"},{"key":"B6","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1080\/19317611.2016.1206051","article-title":"The impact of HIV pre-exposure prophylaxis (PrEP) use on the sexual health of men who have sex with men: a qualitative study in Seattle, WA","volume":"29","author":"Collins","year":"2017","journal-title":"Int J Sex Health"},{"key":"B7","article-title":"Tracking global oral PrEP provision: the who, what and where of oral PrEP","author":"Fitch","year":"2018","journal-title":"HIV Research for Prevention Conference (HIVR4P 2018)"},{"key":"B8","unstructured":"UnitedStates,. PrEPWatch.\n          2021"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.15585\/mmwr.mm6446a4","article-title":"Vital signs: estimated percentages and numbers of adults with indications for pre-exposure prophylaxis to prevent HIV acquisition \u2014 United States, 2015","volume":"64","author":"Smith","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"B10","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1093\/aje\/kwy230","article-title":"Addressing gaps in HIV Preexposure prophylaxis care to reduce racial disparities in HIV incidence in the United States","volume":"188","author":"Jenness","year":"2019","journal-title":"Am J Epidemiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e1003072","DOI":"10.1371\/journal.pmed.1003072","article-title":"Pre-exposure prophylaxis for preventing acquisition of HIV: a cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015\u20132016","volume":"17","author":"Chan","year":"2020","journal-title":"PLoS Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1093\/cid\/ciw367","article-title":"Willingness to take, use of, and indications for pre-exposure prophylaxis among men who have sex with men \u2013 20 U.S. cities","volume":"63","author":"Hoots","year":"2016","journal-title":"Clin Infect Dis"},{"key":"B13","unstructured":"2016"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1778","DOI":"10.1007\/s12325-020-01295-0","article-title":"Barriers to the wider use of pre-exposure prophylaxis in the united states: a narrative review","volume":"37","author":"Mayer","year":"2020","journal-title":"Adv Ther"},{"key":"B15","doi-asserted-by":"publisher","first-page":"265","DOI":"10.17294\/2330-0698.1737","article-title":"HIV preexposure prophylaxis and treatment as prevention \u2014 beliefs and access barriers in men who have sex with men (MSM) and transgender women: a systematic review","volume":"7","author":"Matacotta","year":"2020","journal-title":"J Patient Cent Res Rev"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.1080\/17441692.2016.1154085","article-title":"\u2018I am not a man': trans-specific barriers and facilitators to PrEP acceptability among transgender women","volume":"11","author":"Sevelius","year":"2016","journal-title":"Glob Public Health"},{"key":"B17","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1089\/apc.2015.0266","article-title":"Awareness, interest, and HIV pre-exposure prophylaxis candidacy among young transwomen","volume":"30","author":"Wilson","year":"","journal-title":"AIDS Patient Care STDS"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e25461","DOI":"10.1002\/jia2.25461","article-title":"National trends in HIV pre-exposure prophylaxis awareness, willingness and use among United States men who have sex with men recruited online, 2013 through 2017","volume":"23","author":"Sullivan","year":"2020","journal-title":"J Int AIDS Soc"},{"key":"B19","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1521\/aeap.2015.27.2.112","article-title":"Acceptability of prep uptake among racially\/ethnically diverse young men who have sex with men: the p. 18 study","volume":"27","author":"P\u00e9rez-Figueroa","year":"2015","journal-title":"AIDS Educ Prev"},{"key":"B20","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1080\/00918369.2018.1557953","article-title":"PrEP awareness in the context of HIV\/AIDS conspiracy beliefs among black\/African American and Hispanic\/Latino MSM in three urban US Cities","volume":"67","author":"Olansky","year":"2020","journal-title":"J Homosex"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.1007\/s10461-019-02682-7","article-title":"Low PrEP awareness and use among people who inject drugs, San Francisco, 2018","volume":"24","author":"McFarland","year":"2020","journal-title":"AIDS Behav."},{"key":"B22","doi-asserted-by":"publisher","first-page":"520","DOI":"10.2174\/1570162X12666140129100411","article-title":"PrEP awareness and perceived barriers among single young men who have sex with men in the United States","volume":"11","author":"Bauermeister","year":"2013","journal-title":"Curr HIV Res."},{"key":"B23","doi-asserted-by":"publisher","first-page":"e0184014","DOI":"10.1371\/journal.pone.0184014","article-title":"PrEP awareness and decision-making for latino MSM in San Antonio, Texas","volume":"12","author":"Garcia","year":"2017","journal-title":"PLoS ONE"},{"key":"B24","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1080\/09540121.2018.1533238","article-title":"Barriers to preexposure prophylaxis use among individuals with recently acquired HIV infection in Northern California","volume":"31","author":"Marcus","year":"2019","journal-title":"AIDS Care"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2654","DOI":"10.1007\/s10461-019-02641-2","article-title":"The PrEP care continuum and black men who have sex with men: a scoping review of published data on awareness, uptake, adherence, and retention in PrEP care","volume":"23","author":"Ezennia","year":"2019","journal-title":"AIDS Behav"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1590","DOI":"10.1093\/cid\/civ664","article-title":"Applying a PrEP continuum of care for men who have sex with men in Atlanta, Georgia","volume":"61","author":"Kelley","year":"2015","journal-title":"Clin Infect Dis"},{"key":"B27","doi-asserted-by":"publisher","first-page":"31731","DOI":"10.1097\/QAD.0000000000001385","article-title":"Defining the HIV pre-exposure prophylaxis care continuum","author":"Nunn","year":"2017","journal-title":"AIDS"},{"key":"B28","unstructured":"Prevention Linkage to Care Research: Active Grants2021"},{"volume-title":"Qualitative Research and Evaluation Methods","year":"2002","author":"Patton","key":"B29"},{"key":"B30","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1177\/1525822X02239569","article-title":"Techniques to identify themes","volume":"15","author":"Ryan","year":"2003","journal-title":"Field Methods"},{"key":"B31","first-page":"289","volume-title":"Naturalistic Inquiry","author":"Lincoln","year":"1985"},{"key":"B32","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1016\/S0022-5371(72)80001-X","article-title":"Levels of processing: a framework for memory research","volume":"11","author":"Craik","year":"1972","journal-title":"J Verbal Thinking Verbal Behav."},{"key":"B33","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/COH.0000000000000216","article-title":"What people want from sex and preexposure prophylaxis","volume":"11","author":"Grant","year":"2016","journal-title":"Curr Opin HIV AIDS."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.677716\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T09:44:40Z","timestamp":1638870280000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.677716\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,7]]},"references-count":33,"alternative-id":["10.3389\/fpubh.2021.677716"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2021.677716","relation":{},"ISSN":["2296-2565"],"issn-type":[{"type":"electronic","value":"2296-2565"}],"subject":[],"published":{"date-parts":[[2021,12,7]]},"article-number":"677716"}}