Family-Based Discrimination, Non-disclosure of Sexual Orientation or Gender identity, and Initiation of Oral Pre-exposure Prophylaxis Among Adolescents

This study analyzed the association between family-based discrimination and non-disclosure of sexual orientation or gender identity (SOGI) and the initiation of oral pre-exposure prophylaxis (PrEP) for HIV prevention among adolescent men who have sex with men (AMSM) and transgender women (ATGW). This analysis used baseline data from the PrEP1519 project. Latent class analysis (LCA) was applied to identify patterns of family-based discrimination and non-disclosure of SOGI using three categorical indicators. Descriptive, bivariate, and multivariate analyses were conducted, and logistic regression models estimated the adjusted odds ratios (aOR) for the association between latent classes and PrEP initiation. The majority of the 1,309 participants identified as AMSM (91.4%) were aged 18-19 years (74.9%), were Black and Pardo or mixed race (72.1%), had enrolled in high school (71.9%), resided in São Paulo (49.6%), and lived with parents or other family members (81.9%). Overall, 79.5% of patients initiated oral PrEP. LCA identified three distinct profiles: (i) low discrimination (67.6%, n = 885), (ii) high discrimination (22.4%, n = 293), and (iii) no disclosure within the family context (10.0%, n = 131). Multivariate analysis revealed non-disclosure of SOGI within the family was significantly associated with lower odds of initiating oral PrEP (aOR: 0.54; 95% CI: 0.33-0.78), whereas high levels of family discrimination were not significantly associated with oral PrEP initiation (aOR: 1.22; 95% CI: 0.84-1.76. Enhancing, structural interventions, stronger community support systems, and expanded access to alternative prevention options such as injectable PrEP may improve the initiation and adherence to HIV-prevention efforts among adolescents who experience family-related barriers to disclosure.