How low-income gay and bisexual men who have sex with men navigate financial challenges to HIV pre-exposure prophylaxis use: a qualitative study

Gay and bisexual men who have sex with men (GBMSM) are disproportionately vulnerable to HIV. While prevention efforts emphasize the use of HIV PrEP, low uptake has been attributed to socioeconomic inequities. Even with the U.S. Preventive Services Task Force's designation of PrEP as a "Grade A" prevention service, high out-of-pocket costs for PrEP persist. Yet, limited research has examined how these expenses influence PrEP uptake and use among communities vulnerable to HIV. The purpose of this qualitative study was to explore the role of finances in PrEP use among GBMSM. From January-March 2021, we conducted in-depth interviews with 30 GBMSM about finances and PrEP. Interviews were audio-recorded, transcribed verbatim and thematically analyzed to report semantic-level themes using a four-phase approach. Participants had varying PrEP experiences; 26.7% currently used PrEP, 33.3% previously used PrEP and 40.0% never used PrEP. Thematic analysis identified four themes. Among current and former PrEP users, two themes highlighted the importance of PrEP assistance programs and noted financial strategies to afford PrEP. Among PrEP-naïve participants, two themes emphasized financial and health insurance challenges and factors influencing PrEP accessibility. Findings provide valuable insight into how GBMSM experience and navigate financial-related barriers to PrEP care.