Competing Financial Needs and HIV Pre-Exposure Prophylaxis Use: A Qualitative Study Among Sexual Minority Men
SHARC T32 Postdoctoral Trainee Dr. Jacob Bleasdale represented SHARC at the 2024 American Public Health Association Annual Meeting in Minneapolis, MN, where he presented a first-author oral presentation summarized below:
Background: Sexual minority men (SMM) are disproportionately vulnerable to unmet material needs and HIV. Current HIV prevention efforts emphasize PrEP; however, low uptake has been attributed to socioeconomic inequities. The purpose of this study was to explore PrEP-related costs and financial barriers to PrEP use among SMM.
Methods: Data are from a supplemental study of the Together 5000 cohort examining unmet material needs and PrEP use. From January-March 2021, we conducted in-depth interviews with 30 SMM about finances and PrEP use. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed.
Results: More than one-third of participants identified as Latine (34%), 29% were White, and 22% were Black. Participants had varying PrEP experiences; 27% currently used PrEP, 33% previously used PrEP, and 40% never used PrEP. Current PrEP users highlighted the importance of subsidy programs for alleviating PrEP costs. PrEP users also described implementing various financial strategies (e.g., delaying PrEP refills, limiting expenses) to afford PrEP in the future. Previous PrEP users described low PrEP-related expenses which were largely attributed to insurance coverage and subsidy programs; reasons for discontinuation were not financially motivated. Among PrEP non-users, a primary driver of non-use was lacking health insurance. Non-users described having to choose between affording health insurance or everyday expenses, such as rent or groceries.
Conclusions: Findings highlight the influence of PrEP-related costs and financial barriers on PrEP use, yet such concerns may not influence PrEP discontinuation among some SMM. Improving access to affordable healthcare and enrollment in subsidy programs may improve PrEP uptake.