Concerns regarding PrEP accessibility and affordability among ymsm

• 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 theoptimal rollout of PrEP among YMSM in the United States. Assess how sociodemographic characteristics may beassociated with YMSMs PrEP awareness and accessibility and affordability beliefs. Consider multilevel strategies that maximize equity inaccess 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 theFDA in July 2012. PrEP has been proven highly effective for the prevention ofHIV in MSM when paired alongside comprehensive behavioral strategies. PrEP has had minimal promotion in health service settings Awareness? Uncertainty? Capacity? 5. 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 socialnetworking sites 6. Sample Characteristics SURVEY PARTICIPANTS BY RACE (N=1,507), Age 18-24BlackLatinoWhite 9%Other race/ethnicity9% 17%65% 7. Sample Characteristics N=1,507N(%)Residentially Unstable (30 days)210 (13.9%)Ever sent to jail/prison113 (7.5%)Covered by any insurance1221 (81.0%)Sexual Behaviors Sexually Active in prior 2 months1062 (70.5%)URAI in past 2 months427 (28.3%)Prior HIV/STI (lifetime) HIV-positive Other Sexually-Transmitted Infection19 (1.3%) 224 (14.8%) 8. Who has heard of PrEP? 27% of the sample had heard about PrEP in the past. Multivariate Logistic RegressionOR95% CISig.Age1.13(1.05, 1.21).001Black1.09(.71, 1.68).696Latino.93(.67, 1.29).660Asian/Pacific Islander1.04(.57, 1.89).908Multiracial1.02(.54, 1.93).964Other.68(.22, 2.09).497Educational Attainment1.19(1.07, 1.34).002Residentially Unstable (30 days)1.37(.98, 1.91).069Ever sent to jail/prison.63(.38, 1.03).067Covered by insurance1.50(1.07, 2.09).018URAI in past 2 months1.20(.93, 1.57).164Prior STI/HIV1.79(1.31, 2.43).001Race/Ethnicity 9. PrEP Perceptions & Beliefs Among those who had heard about PrEP (N=410): Over a third (36.4%) agreed that they would not take PrEPdue to side effect concerns. (M = 2.30, SD = .93) Less than half (48%) reported knowing how to access PrEP ifthey 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) 10. I would not take PrEP drugs because I am concerned about their side effects.N=410I could not afford PrEP drugs.BSESig.bSESig.(Constant)1.75.56.0022.38.53.001Age.02.03.453.05.03.085Black.57.17.001.05.16.771Latino.31.13.018-.06.12.617Asian/Pacific Islander.31.23.184-.71.22.002Multiracial.40.25.115.21.24.381Other-.37.48.444-.67.45.141Educational Attainment-.04.05.365-.05.04.239Residentially Unstable (30 days).04.13.761.13.12.306Ever sent to jail/prison.16.21.449.23.20.246Covered by insurance.22.14.116-.53.13.001URAI in past 2 months-.16.10.112-.05.10.585Prior STI/HIV-.02.11.846.33.11.002Race/Ethnicity 11. 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 12. 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 toconsider whether PrEP is a viable option in their lives 13. A roadmap to PREP 14. Contact information [email protected]