CROI 2019 Abstract eBook

Abstract eBook

Oral Abstracts

reviewed. The implications of these findings for the development of new PrEP products and delivery approaches will be considered. 164 MAKING PREVENTION WORK FOR YMSM: BRIDGING REAL-WORLD NEEDS THROUGH DIGITAL ENGAGEMENT Lisa Hightow-Weidman , University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Despite evidence for the efficacy of treatment as prevention as both antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP), uptake and sustained retention in the prevention and care continuum for young men who have sex with men (YMSM) is suboptimal. Thus, both in the United States and globally, YMSM remain disproportionately impacted by HIV. The effectiveness of ART for reducing HIV transmission requires successes at multiple steps of the HIV prevention and care continuum (HIV testing, PrEP or ART treatment initiation, and treatment adherence), which may prove challenging for YMSM due to individual, structural, and societal barriers. Comprehensive, evidence-based behavioral, psychosocial, and structural interventions are needed to optimize PrEP and treatment as prevention among YMSM. Technology-delivered interventions are well-suited for YMSM given their modality, the ubiquity of technology in the population, and the platform’s suitability for delivering tailored content specific to each users’ unique needs. These interventions can be particularly useful for YMSM who, due to anticipated or actual stigma, are unable or unwilling to talk to providers about their same-sex attractions and behaviors, and yet are in need of prevention and care services. However, the strategies to “make prevention work” for YMSMmust maximize the potential for digital tools to address gaps in the cascade, and ensure that engagement bridges the resources shared through the digital world with their real-world needs. The accessibility and anonymity of online spaces may provide a particularly powerful intervention modality for amplifying resilience and empowerment thus countering the stereotypes and social institutions that perpetuate HIV-related stigma, racism, and blame experienced by YMSM. A brief review on how the use of technology, specifically, mobile health (mHealth) has evolved as seen from the lens of researcher, provider and patient/participant will be provided. Use of mHealth to mitigate stigma, improve patient-provider communication and provide social support - all factors known to be important

in prevention and care outcomes – will be discussed. Practical strategies, best practices and future innovations will be presented. 165 DON’T LEAVE THEM BEHIND: HETEROSEXUAL YOUNG AFRICAN MEN Webster Mavhu , Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe Background: The number of young people living in Africa (15-24 years) is projected to double over the next 30 years. Africa’s ability to benefit from this population growth will depend on their health and well-being. High HIV incidence among young people may drive rises in the absolute numbers of new infections. Whilst HIV prevention initiatives are focusing on specific subgroups of young people (e.g. adolescent girls and young women, young men and women selling sex, men having sex with men), young heterosexual men are being left behind. As for adult men, adolescent and young men are less likely to seek health services than their female counterparts, with research suggesting that this is at least in part due to shame or the need to “save face”. Indeed, a well-recognized notion is that help-seeking can be seen as a threat to masculine identity in both adult and young males, due to masculinity-related cultural constructs which conflate help-seeking behavior with being “weak”. Supply-side barriers include stigmatizing attitudes of providers about sexuality and, limited youth-friendly services. Studies conducted in sub-Saharan Africa (SSA) suggest that efforts to engage and interest male youth in HIV prevention could include: offering them free or low-cost specific sexual & reproductive health and HIV services, creating separate and confidential spaces for them, intensifying efforts to sensitize health-care workers to be more “youth friendly”, in particular, respecting confidentiality, being nonjudgmental and accommodating young men’s concerns of looking “weak”. Conclusions: The population-level impact of youth-focused HIV prevention interventions being implemented in SSA will be diminished if young heterosexual men continue to be left behind. Lessons learned from innovative approaches to enhance voluntary medical male circumcision uptake, including use of HIV self-testing and harnessing female peers’ influence, could inform design and implementation of other male youth-focused HIV prevention initiatives. Setting the pattern for healthy health-seeking behavior in adolescents will likely have benefits throughout the life course.

Oral Abstracts

60

CROI 2019