Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Trace Kershaw

Second Advisor

John Pachankis


Pre-exposure prophylaxis (PrEP) has revolutionized HIV prevention in the last ten years, as it is highly effective at preventing infection. PrEP is a strong preventive option for those at risk of HIV, but only 30% of those who could benefit from it were prescribed PrEP in the United States in 2021.2 The purpose of this study is to investigate how mental health, internalizations, and greater contextual factors unique to sexual minority men and nonbinary individuals (SMMNI) impact PrEP knowledge, uptake, and adherence. Survey data from the #MVMNT (Men’s Voices on Mapping, Networks, and Technology) project was utilized to examine the relationship between various social, emotional, and contextual factors and PrEP awareness, initiation, and use. PrEP efficacy and stigma were analyzed as potential mediators. We found that 97% of participants had heard of PrEP and 41.6% of those aware had tried PrEP, and 67.1% of those who had tried PrEP currently used it (27.2% of the sample). Insurance and medical mistrust had positive associations with PrEP initiation. Increased depression, internalized homophobia, and HIV risk as well as decreased concealment were positively associated with current PrEP use. There was no significant mediation. This study suggests that relationships to the healthcare system are the largest barrier to PrEP initiation and internalized ideas about sexuality and risk as well as mental health had a complex relationship with ongoing PrEP use.


This is an Open Access Thesis.

Open Access

This Article is Open Access