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In 2012, the Federal Drug Administration approved daily oral pre-exposure prophylaxis (PrEP) for HIV prevention in adults. Longer acting injectable PrEP (LA PrEP) has been approved and other formulations are in development. A successful LA PrEP rollout requires examining potential facilitators and barriers to PrEP uptake. Given that transgender and gender expansive (TGE) individuals experience more social vulnerability and higher levels of medical mistrust compared to other populations, examining the role of these two factors in LA PrEP uptake is important. This study, PrEP for ALL, is a community-based participatory research project in Texas that engaged TGE community members and organizational partners through a community advisory board. In total, 482 TGE individuals were recruited and responded to all relevant questions in an online survey, including their intentions to use three formulations: a monthly oral pill, a bimonthly intramuscular injection, and an annual subdermal implant. Multiple regression analysis was used to examine the influence of social vulnerability and medical mistrust on intention to use each LA PrEP formulation adjusting for other relevant factors. Findings suggest that individuals with higher levels of social vulnerability had greater intentions to use the monthly oral pill (β = 0.12, p = 0.009), the bimonthly intramuscular injection (β = 0.18, p < 0.001), and annual subdermal implant (β = 0.17, p < 0.001), whereas medical mistrust reduced intentions to use the bimonthly intramuscular injection (β = −0.18, p < 0.001) and annual subdermal implant (β = −0.11, p = 0.021). Improvements in gender-affirming clinical care are needed along with LA PrEP formulations that allow for greater autonomy and reduced clinical contact. Clinical Trial Registration number: NCT05044286. [ABSTRACT FROM AUTHOR]

Sexual compulsivity has been associated with higher frequencies of sexual behaviors that may increase risk for transmission of HIV and other sexually transmitted infections (STI). In a rural midwestern region where social and community resources for the sexual health of men who have sex with men (MSM) are relatively few, the patterns of partner-seeking and sexual behavior, and their relations to sexual compulsivity, may be different than findings from other assessments of men in urban centers. Using a community-based participatory approach (CBPR), data were collected from 309 men who were primarily white, identified as gay or homosexual, and had a mean age of 29.37 years (SD = 11.33), to explore relations between scores on a measure of sexual compulsivity and their sexual partner-seeking, drug and alcohol use, and sexual behaviors with men and women. The majority of men reported having engaged in sexual activity with men in the past 30 days. Those scoring higher than the sample mean (1.65 [SD = 0.66]) on the sexual compulsivity measure reported patterns of having sex with partners met online and having been the insertive or receptive partner in unprotected anal intercourse. Given the unique patterns of sexual partner-seeking in this area, interventions to decrease sexual risk-taking should take into account that the vast majority of men in rural areas are using the Internet to locate sexual partners, and prevention messages focused on rural contexts need to be tailored to include men who have a propensity for sexually compulsive behaviors. Additionally, interventions created for virtual spaces may be more sustainable with rural communities than traditional approaches to HIV/STI prevention. DOI: 10.1089/apc.2010.0117