Awareness and use of pre-exposure prophylaxis in a United States national sample of young sexual and gender minority men

Young sexual and gender minority (SGM) men remain disproportionately affected by the HIV epidemic. Although pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV acquisition, uptake among SGM men in the United States (US) remains suboptimal. To better understand disparities in PrEP awareness, use, and adherence, we examined baseline survey data from the Limited Interaction Targeted Epidemiology (LITE-2) cohort, which included 3,148 young SGM men (age 17-29) across the US and its territories. Bivariate chi-square with pairwise post-hoc comparisons with effect sizes were used to characterize PrEP awareness and uptake by race, ethnicity, gender, age, number of sex partners, education, and income with additional comparisons by participant health insurance status, state Medicaid expanded category, and region. PrEP adherence with recent daily oral PrEP use was described across insurance type and open-response reasons for PrEP discontinuation were thematically summarized. While over 90% of participants had heard of PrEP, only about half had ever used it, and roughly one-third were current users. Disparities in uptake were most pronounced across socioeconomic variables (income, education, insurance). These findings underscore the need for tailored, equity-focused strategies to expand PrEP access and utilization, especially in EHE priority regions.