Background: Despite decreasing rates of HIV among many populations, HIV-related
health disparities among gay, bisexual and other men who have sex with men persist, with disproportional
percentages of new HIV diagnoses among racial and ethnic minority men. Despite increasing
awareness of HIV pre-exposure prophylaxis (PrEP), PrEP use remains low. In addition to exploring
individual-level factors for this slow uptake, structural drivers of PrEP use must also be
identified in order to maximize the effectiveness of biomedical HIV prevention strategies.
Method: Using cross-sectional data from an ongoing cohort study of young sexual minority men
(N=492), we examine the extent to which structural-level barriers, including access to health care,
medication logistics, counseling support, and stigma are related to PrEP use.
Results: While almost all participants indicated awareness of PrEP, only 14% had ever used PrEP.
PrEP use was associated with lower concerns about health care access, particularly paying for PrEP.
Those with greater concerns talking with their provider about their sexual behaviors were less likely
to use PrEP.
Conclusion: Paying for PrEP and talking to one’s provider about sexual behaviors are concerns for
young sexual minority men. In particular, stigma from healthcare providers poses a significant barrier
to PrEP use in this population. Providers need not only to increase their own awareness of and
advocacy for PrEP as an effective risk-management strategy for HIV prevention, but also must work
to create open and non-judgmental spaces in which patients can discuss sexual behaviors without
the fear of stigma.