University of Massachusetts Medical School Faculty Publications


Potential Healthcare Insurance and Provider Barriers to Pre-Exposure Prophylaxis Utilization Among Young Men Who Have Sex with Men

UMMS Affiliation

Department of Quantitative Health Sciences; Center for Health Policy and Research, Commonwealth Medicine

Publication Date


Document Type



Community Health and Preventive Medicine | Health Economics | Health Policy | Health Services Administration | Immune System Diseases | Virus Diseases


Young adult men-who-have-sex-with-men (YMSM) continue to have among the highest incidence of HIV infection in the United States. Pre-exposure prophylaxis (PrEP) is an effective and safe method of preventing HIV infection; however, despite US Food and Drug Administration approval, utilization remains low, in part, due to structural barriers, particularly access to healthcare. In this study, we used social media to recruit black, Hispanic, and white HIV-uninfected 18- to 24-year-old YMSM. Participants completed an online survey about their sexual behavior, healthcare access, and previous use of PrEP. Of the 2297 YMSM surveyed, only 3.4% had used PrEP. PrEP use was associated with higher levels of education, living alone, older age, higher levels of sexual activity, and greater healthcare access, specifically having healthcare insurance and a clinic or primary care provider (PCP) from whom they received care. Among PrEP nonusers, 65% met at least one of the US Centers for Disease Control and Prevention recommended indications for PrEP use, and of these, 59% had healthcare insurance and received care in a clinic and/or had a PCP. Multi-variable multi-nomial logistic regression modeling identified disparities in access to healthcare by age, race/ethnicity, education, and region. Specifically, older YMSM, blacks and Hispanics, those with fewer years of formal education, and residents of the southern and the western United States were more likely to lack healthcare access. These results demonstrate both potential opportunities and barriers to the scale-up of PrEP among YMSM.


HIV, PrEP, YMSM, healthcare

DOI of Published Version



AIDS Patient Care STDS. 2017 Nov;31(11):470-478. doi: 10.1089/apc.2017.0171. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

AIDS patient care and STDs

PubMed ID