Background
The population-level impact of HIV PrEP in the US has been limited by structural barriers to access, particularly in historically marginalized populations. Making PrEP available over the counter (OTC) on pharmacy shelves or online, without the need for a prescription, may address some of those barriers. However, it is unknown if populations likely to benefit from PrEP would support OTC availability.
Methods
We analyzed cross-sectional data from the Transgender Women’s Internet Survey and Testing study from December 2023-May 2024. Respondents were US transgender women and transfeminine non-binary people assigned male at birth who were aged ≥15 and reported ever having sex. Respondents were asked whether or not they would support making daily oral PrEP available OTC if research showed it was safe and effective. We used modified Poisson regression to compute unadjusted prevalence ratios (PR) to identify correlates of support for OTC PrEP.
Results
Among 1,918 respondents, median age was 24 years, 75% were white, and 11% PrEP-experienced. Overall, 87% supported OTC PrEP; 7% did not support it and 6% were unsure. Support for OTC PrEP did not differ by age, race, or ethnicity but was higher among respondents with >1 sex partner in the prior year compared with those with 0-1 partner(s) (PR=1.04, 95% CI=1.02-1.07) and among respondents with a recent bacterial STI (PR=1.08, CI=1.06-1.09). There was greater OTC PrEP support among respondents who had ever worried that a healthcare provider would treat them differently due to the respondent’s gender identity (PR=1.04, CI=1.01-1.07) or sexual partnerships (PR=1.03, CI=1.01-1.06). Among PrEP-naïve respondents, there was greater support for OTC PrEP among those who reported they had never taken PrEP because they were worried a doctor would treat them poorly if they asked about PrEP (PR=1.05, CI=1.01-1.09), people would think they were very sexually active (PR=1.07, CI=1.04-1.10), or about privacy while insured by a parent’s health plan (PR=1.06, CI=1.03-1.09). Support for OTC PrEP was also higher among those who had never taken PrEP because they did not know enough about it (PR=1.04, CI=1.00-1.07) or which doctor to see to access it (PR=1.06, CI=1.03-1.09).
Conclusions
Support for OTC PrEP was high among transgender women and transfeminine non-binary people, especially those who anticipated stigma in healthcare settings. Future research should explore how OTC PrEP might address barriers to PrEP use experienced by historically marginalized populations.