Navigating Access to Pre-exposure Prophylaxis (PrEP): Black Men Who Have Sex With Men (BMSM) Voices Living in HIV Hotspots

Pre-exposure prophylaxis (PrEP) has contributed significantly to stabilizing HIV incidence rates across most populations. However, significant disparities in HIV incidence and PrEP uptake persist among Black men who have sex with men (BMSM). This study delved into the individual, sociocultural, and structural factors associated with PrEP access and uptake among 28 BMSM residing in designated HIV hotspots. Participants were recruited from communities identified as "high priority" by the US Department of Health and Human Services' Ending the HIV Epidemic in the US initiative. Participants completed semi-structured interviews focusing on PrEP awareness, access, and barriers to uptake. Guided by the Socioecological Model, key themes were identified and organized into individual, sociocultural, and structural (systemic) factors that affect PrEP access and health behaviors. Participants described individual barriers related to misinformation, potential side effects, adherence, and low perceived risk for acquiring HIV. Participants described sociocultural and structural barriers to PrEP uptake associated with stigma and PrEP shaming, affordability, the lack of physical access to providers, or non-affirming provider interactions. Overall, misconceptions, negative provider experiences, and stigma significantly limited PrEP access for the BMSM in this study. These findings underscore the need for multi-level public health approaches that address these intersecting barriers. Such strategies must be adaptable to the unique social and geographic characteristics of the BMSM population being served to optimize PrEP access and reduce HIV disparities.