Education and employment support for HIV prevention in young adults (ENSPIRE)

Univ Of North Carolina Chapel Hill, Chapel Hill NC

Investigators

Abstract

Abstract: This study evaluates the effectiveness of a combination intervention providing education, employment support, resources, and mentoring on uptake of HIV prevention medication and behaviors in U.S. young adults. Approximately 1.2 million Americans are currently living with HIV, and many more are at risk of HIV infection. While new HIV diagnoses have declined in recent years, an estimated 38,000 Americans are newly diagnosed each year. Young adults represent a growing proportion of new HIV diagnoses in the U.S. and are more likely to acquire HIV infection compared to older adults due to limited education on prevention of sexually transmitted infections (STI), higher rates of sexual risk behaviors, and lower access to HIV prevention therapies. Young adults also face higher rates of economic hardship, such as unemployment, job instability, homelessness, or low wage – which are associated with higher rates of HIV. Pre-exposure prophylaxis (PrEP) is a medication that can prevent HIV infection in individuals who do not have HIV but are at risk of contracting it. Research has shown that PrEP is highly effective in preventing HIV transmission through sexual activity among individuals who are at risk of HIV infection. Yet, young adults make-up a small proportion of PrEP users in the United States. Barriers to uptake of PrEP are often economic in nature if potential users are uninsured or if, even with health insurance, potential users lack income to pay for out-of-pocket expenses relating to medications, lab monitoring, or travel to clinics. In addition, young adults experiencing economic hardship are often unaware of the benefits of PrEP, how to access it, how to pay for it, and how to discuss HIV prevention medications and behaviors with their sex partners or healthcare providers. Therefore, interventions that provide education on HIV prevention and that provide support to enhance access to employment and cost-assistance programs are needed. This study will randomize U.S. young adults to an experimental group that will receive HIV prevention education (i.e., PrEP, condomless sex), economic resources, job announcements, job readiness training, and employment mentoring or to a control group that will receive job announcements only. We will recruit sexually active young adults, aged 18 to 24, who are experiencing economic hardship. The specific aims are to: (1) evaluate the effectiveness of the intervention on condomless sex and PrEP initiation, as well as participants’ economic stability as achieved by enhanced employment; (2) assess heterogeneity of intervention effects by sex and by peer support; and (3) examine mechanisms of change and component experiences using statistical and qualitative methods.