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Sexual minority stressors (community homophobia, sexuality-related discrimination, and internalized homonegativity) are negatively associated with accessing HIV prevention services among men who have sex with men (MSM). Few studies have tested minority stressors' associations with PrEP engagement among high-HIV risk young MSM (YMSM). Therefore, we assessed the associations between PrEP-indicated YMSM's progression along the PrEP continuum and their experiences of minority stress. N = 229 YMSM completed a web-survey on PrEP-related behaviors and minority stress. Adjusted for covariates, we developed two partial-proportional odds models examining the associations between PrEP continuum progression and minority stressors, as a composite, and community homophobia, sexuality-related discrimination, and internalized homonegativity, respectively. Our multivariable model demonstrated minority stress levels to be negatively associated with PrEP continuum location (AOR = 0.76, 95% CI: 0.58–0.99). Broken down, discrimination was positively associated with reporting being at an advanced location along the continuum (AOR = 1.39, 95% CI: 1.06–1.82). Internalized homonegativity was negatively associated with continuum location between PrEP-aware participants with no intention to initiate and participants who intended to initiate PrEP (AOR = 0.45, 95% CI: 0.27–0.77) and between those who intended to initiate and those who had ever used PrEP (AOR = 0.39, 95% CI: 0.22–0.69). Our findings suggest that minority stress, especially internalized homonegativity, remains a barrier to PrEP among PrEP-indicated YMSM. Sexuality-related discrimination was associated with PrEP continuum progression, suggesting potentially well-developed, adaptive coping skills (e.g., ability to locate sexuality-affirming providers). Coupled with stigma reduction efforts, HIV prevention services aiming to promote PrEP should incorporate internalized homonegativity screenings and referrals into sexuality-affirming resources for PrEP-indicated YMSM. [ABSTRACT FROM AUTHOR]

The Middle East and North Africa (MENA) is one of only two global regions where rates of HIV are currently on the rise. In Lebanon, new HIV infections are increasing most rapidly among young men who have sex with men (YMSM). While, the majority of YMSM in Lebanon report having recently engaged in condomless anal intercourse, many report reluctance to seek HIV prevention services for fear of stigma and discrimination. Pre-exposure prophylaxis (PrEP) is an effective alternative HIV prevention strategy but there is a dearth of research looking at willingness to take PrEP among YMSM in MENA. This study is the first to delineate factors associated with willingness to take PrEP among a cohort of 218 YMSM recruited from Beirut, Lebanon. Over half (55.5%) reported willingness to take PrEP. At the bivariate level, knowledge of HIV risk, awareness of PrEP, being in a relationship, greater judgementalism about sex in communication with peers, greater number of types of gay-related discrimination experienced, sense of community among YMSM, having had recent condomless anal sex with positive or unknown status partner, and the use of substances just prior to or during sex were each associated with greater willingness to take PrEP. When entered into a linear regression analysis, use of substances just prior to or during sex and sense of community among YMSM remained significant predictors of PrEP willingness. Intervention efforts focused on increasing PrEP uptake among YMSM in MENA should consider the influence substance use and social factors on willingness to take PrEP. [ABSTRACT FROM AUTHOR]