HIV Pre-Exposure Prophylaxis Among Sexual and Gender Minority Homeless Youth

Sexual and gender minority (SGM) people account for up to 40% of youth experiencing homelessness. SGM youth experiencing homelessness report a higher likelihood of engaging in behavior that puts them at risk of acquiring HIV. To address this increased risk, it is necessary to identify difference in awareness and use of HIV pre-exposure prophylaxis (PrEP) among SGM youth experiencing homelessness.

Using intake forms from a single service provider in New York City, New York, that specializes in providing shelter and health care for SGM youth experiencing homelessness, we conducted a retrospective, cross-sectional study examining associations between access to care and engaging in transactional sexual exchanges (TSEs) with awareness and use of HIV PrEP.

Of 1312 SGM youth, 63.1% (n = 828) reported being aware of HIV PrEP, but only 11.7% (n = 153) had ever taken HIV PrEP. Access to care was associated with being aware of HIV PrEP (odds ratio [OR] 1.57, 95% CI [1.20-2.07]) but not ever using it (OR 1.47, 95% CI [0.94-2.29]). Notably, previous use of HIV PrEP was higher among SGM youth who had engaged in TSE than among those who had not (OR 3.55, 95% CI [2.47-5.08]).

Access to medical care is associated with awareness but not utilization of HIV PrEP. Providing HIV preventive care for SGM youth experiencing homelessness requires more than access to care. Further research is needed to assess facilitators and barriers to HIV PrEP utilization in this population.