1. Concerns regarding PrEP Accessibility and
Affordability Among YMSM in the U.S.
Jose A. Bauermeister
Emily Pingel
Steven Meanley
Laura Jadwin-Cakmak
Gary W. Harper

2. Conflict of Interest
 No conflicts to disclose or report.

3. Agenda
 Identify how structural conditions may hinder the
optimal rollout of PrEP among YMSM in the United
States.
 Assess how sociodemographic characteristics may be
associated with YMSM’s PrEP awareness and
accessibility and affordability beliefs.
 Consider multilevel strategies that maximize equity in
access and use among YMSM interested in considering
PrEP as a prevention strategy.

4. The Current PrEP Climate
 Truvada was approved as a preventative measure by the
FDA in July 2012.
 PrEP has been proven highly effective for the prevention of
HIV in MSM when paired alongside comprehensive
behavioral strategies.
 PrEP has had minimal promotion in health service settings
 Awareness?
 Uncertainty?
 Capacity?

6. Sample
 Cross-sectional web-survey (July 2012-January 2013)
 Identification of unique cases (remove duplicate/frauds)
 77% Participation Rate (N=1,507)
 Eligibility criteria:





Cis-male
Ages 18-24 (M=20.80 years)
Single
Sex with other men
US resident (including Puerto Rico)
 Recruitment through advertisements on two social
networking sites

7. Sample Characteristics
SURVEY PARTICIPANTS BY RACE
(N=1,507), Age 18-24
Black
Latino
White
9%
Other race/ethnicity
9%
17%
65%

8. Sample Characteristics
N=1,507
N(%)
Residentially Unstable (30 days)
210 (13.9%)
Ever sent to jail/prison
113 (7.5%)
Covered by any insurance
1221 (81.0%)
Sexual Behaviors
Sexually Active in prior 2 months
1062 (70.5%)
URAI in past 2 months
427 (28.3%)
Prior HIV/STI (lifetime)
HIV-positive
Other Sexually-Transmitted Infection
19 (1.3%)
224 (14.8%)

9. Who has heard of PrEP?
 27% of the sample had heard about PrEP in the past.
Multivariate Logistic Regression
OR
95% CI
Sig.
Age
1.13
(1.05, 1.21)
.001
Black
1.09
(.71, 1.68)
.696
Latino
.93
(.67, 1.29)
.660
Asian/Pacific Islander
1.04
(.57, 1.89)
.908
Multiracial
1.02
(.54, 1.93)
.964
Other
.68
(.22, 2.09)
.497
Educational Attainment
1.19
(1.07, 1.34)
.002
Residentially Unstable (30 days)
1.37
(.98, 1.91)
.069
Ever sent to jail/prison
.63
(.38, 1.03)
.067
Covered by insurance
1.50
(1.07, 2.09)
.018
URAI in past 2 months
1.20
(.93, 1.57)
.164
Prior STI/HIV
1.79
(1.31, 2.43)
.001
Race/Ethnicity

10. PrEP Perceptions & Beliefs
 Among those who had heard about PrEP (N=410):
 Over a third (36.4%) agreed that they would not take PrEP
due to side effect concerns.
 (M = 2.30, SD = .93)
 Less than half (48%) reported knowing how to access PrEP if
they wanted it.
 (M = 2.47, SD = 1.06)
 YMSM were most likely to agree or strongly agree (61.2%)
that they could not afford to take PrEP.
 (M = 2.78, SD = .92).
Beliefs ascertained on 4-point scale (1=Strongly Disagree; 4 = Strongly Agree)

11. I would not take PrEP drugs because I am
concerned about their side effects.
N=410
I could not afford PrEP drugs.
B
SE
Sig.
b
SE
Sig.
(Constant)
1.75
.56
.002
2.38
.53
.001
Age
.02
.03
.453
.05
.03
.085
Black
.57
.17
.001
.05
.16
.771
Latino
.31
.13
.018
-.06
.12
.617
Asian/Pacific Islander
.31
.23
.184
-.71
.22
.002
Multiracial
.40
.25
.115
.21
.24
.381
Other
-.37
.48
.444
-.67
.45
.141
Educational Attainment
-.04
.05
.365
-.05
.04
.239
Residentially Unstable (30 days)
.04
.13
.761
.13
.12
.306
Ever sent to jail/prison
.16
.21
.449
.23
.20
.246
Covered by insurance
.22
.14
.116
-.53
.13
.001
URAI in past 2 months
-.16
.10
.112
-.05
.10
.585
Prior STI/HIV
-.02
.11
.846
.33
.11
.002
Race/Ethnicity

12. Addressing Individual Barriers
 Knowledge as a barrier
 YMSM knowing about and understanding PrEP
 What it is
 How it works
 Adequacy for me
 How to get it
 Perceived barriers
 Racial/ethnic differences in side effect beliefs
 Affordability based on insurance and risk profiles
 Raise YMSM self-efficacy & access
 PrEP as a viable option
 Getting PrEP without insurance

13. Connecting to PrEP
 More PrEP advocacy in the HIV/AIDS political realm
 Resistance to funding PrEP access and education
 Insurance coverage
 Aiding HIV/AIDS Service Providers aid YMSM to
consider whether PrEP is a viable option in their lives

14. A roadmap to PREP…

15. Contact information
jbauerme@umich.edu