Oral pre-exposure prophylaxis (PrEP) either taken daily or on demand is highly effective in preventing HIV transmission when taken as prescribed.1, 2, 3 However, there are many factors that influence whether a person is a good candidate for PrEP, as PrEP requires multiple clinical visits for screening, counseling and ongoing monitoring – all of which necessitate a substantial amount of health literacy to navigate our current healthcare system.4 Additionally, there are behavioral factors, such as condomless sex5, 6 which increases risk for HIV acquisition, and socioeconomic factors, such as educational attainment and income status,7, 8, 9 that influence PrEP uptake and preferences for different PrEP modalities. These factors may also act as barriers to PrEP services that particularly affect young adult men who have sex with men (MSM) of color, who are at highest risk of acquiring HIV10 and transgender women, who are often overlooked in HIV prevention efforts.

In addition to the barriers mentioned above, there has been a recent wave of negative rhetoric surrounding LGBTQ rights. As of May 2023, there are 491 anti-LGBTQ bills, many that aim to restrict access to gender affirming care,11 as well as challenges to current federal mandates requiring insurance coverage for PrEP, ie Braidwood Management v Becerra12 – all of which could create further obstacles to “Getting to Zero,” and initiative to end HIV infections in the U.S. by the year 2030.13

Since the U.S. Food and Drug Administation (FDA) approval of oral PrEP (Truvada and Descovy), new cases of HIV have declined dramatically among White individuals yet the same cannot be said for people of color.14 Disparities in HIV incidence still exist – there were over 36,000 individuals diagnosed with HIV in 2021, 40% of new HIV diagnoses were in Black Americans, 29% of new HIV diagnoses were in Hispanic/Latino communities, compared to 25% of new HIV diagnoses in White Americans.15 Black men who have sex with men (BMSM) have the greatest risk of acquiring HIV in the United States. During their lifetimes, 1 of every 2 BMSM will receive an HIV diagnosis.10 Transgender women are 34 times more likely to live with HIV compared to the general population,16 yet transgender women (TW) have limited knowledge and uptake of PrEP despite its proven effectiveness at reducing HIV. Overall, these factors contribute to the low uptake of PrEP among sexual minority men and TW.4, 17

In December 2021, the FDA and the Center for Disease Control (CDC) approved cabotegravir (a long-acting injection) for HIV prevention18 and Islatravir, which could be offered as a weekly oral pill or a long-acting implant and is currently being studied as a potential alternative delivery method of PrEP.19 Longer-acting forms of PrEP are preferred by South African cis-gender young adults over a daily pill.20 In one study, young MSM and TW in the U.S. agreed that injectable PrEP would be more suitable for those who frequently engaged in sex.5 Numerous factors have been found to affect PrEP selection among adult sexual minority men and prior evidence suggests that a preference for LAI PrEP may be due to perceptions of reduced adherence barriers in comparison to taking a daily pill, negative experiences with oral PrEP among peers, and PrEP-related stigma.21 Additionally, sexual minority men with less education were more likely to prefer LAI PrEP compared to men with higher levels of education.22 Those who prefer injectable PrEP were more likely to be Black or Hispanic, engage in frequent condomless anal sex, and previously used oral PrEP.23 Sexual minority men who engage in frequent sex and chemsex (use of illicit drugs in sexual contexts) are more likely to switch from on demand PrEP to daily PrEP.6 Attitudes and preferences of diverse young sexual minority men and TW towards longer acting formulations of PrEP have not been well studied.

Given the knowledge gap about preferences for HIV prevention among young adult MSM and TW, particularly preferences for the newest form of prevention, LAI PrEP, the purpose of this study is to describe awareness of, attitudes towards, and preferences for initiating LAI PrEP in comparison to other HIV prevention strategies including condoms, oral pill (Truvada or Descovy, either taken daily or on demand), as well as factors associated with a preference for LAI PrEP, in particular, over other HIV prevention strategies. Given prior study findings,20, 21, 22, 23 we hypothesize that healthcare engagement and literacy, having a provider, being a youth of color, a recent history of anal sex, prior PrEP use, and PrEP efficacy would be associated with a preference for LAI PrEP.