Concerns regarding PrEP accessibility and affordability among YMSM in the United States

Pre-exposure prophylaxis (PrEP) has the potential to help reduce new HIV/AIDS infections among young men who have sex with men (YMSM); however, PrEP's accessibility and affordability remains questionable. Using a cross-sectional survey of YMSM (N=1,507; ages 18-24; 65% White, 9% Black, 17% Latino, 9% Other race/ethnicity), we gauged YMSM's PrEP awareness and PrEP-related beliefs regarding accessibility and affordability. Overall, 27% of the sample had heard about PrEP; 1% reported ever using PrEP prior to sex. In a multivariate logistic regression, we found that YMSM were more likely to have heard about PrEP if they were older (OR=1.12), more educated (OR=1.20), had insurance (OR=1.47), and reported at least one sexually-acquired infection (STI) in their lifetime (OR=1.81). We noted no differences by sexual risk behavior or race/ethnicity. Once a description of PrEP was offered to survey participants, two thirds of the sample (64.4%) noted that they would not know where to acquire PrEP, nor believed that they would able to afford it (62.4%). In multivariate linear regression models, YMSM's belief of PrEP accessibility was associated with insurance (b=.24), identifying as Latino (b=.23) or Asian (b=.42), and having heard about PrEP in the past (b=.40). PrEP affordability belief was associated with insurance (b=-.44) and a prior STI (b=.21). Black (b=-.28), Asian (b=-.07), or Other Race/Ethnicity (b=-.52) YMSM were less likely than Whites to report PrEP affordability belief. PrEP rollout may be hindered due to awareness, accessibility and affordability barriers. We propose strategies to maximize equity in PrEP awareness, access and use among YMSM.