Activity Space Mapping and Pre-Exposure Prophylaxis Uptake Among Gay, Bisexual, and Other Sexual Minority Men in Small Cities and Towns in the United States.

In the US, gay, bisexual, and other sexual minoritized men (GBSMM) remain disproportionately impacted by HIV, and continue to experience unmet needs for pre-exposure prophylaxis (PrEP). A growing body of literature has underscored the need to consider the geographic factors of HIV prevention, particularly beyond administrative boundaries and towards localized spaces that influence the accessibility and utilization of health-promoting resources. Therefore, the purpose of this study is to examine the associations of driving times from activity spaces to PrEP offering facilities and individual PrEP uptake. A total of 218 GBSMM (ages 18-34) from Connecticut and Georgia were sampled from a longitudinal cohort study. We used the getis-ord-gi statistic to examine the spatial clustering of PrEP offering facilities, and generalized estimating equations (GEE) and post-hoc moderation analyses to explore the state interactions on driving time and PrEP uptake. Our main findings suggest that for participants in Connecticut, state of residence was a significant moderator on driving time and ever hearing of PrEP and ever taking PrEP. Whereas for participants in Georgia, state of residence moderated the likelihood of returning to activity spaces of participants in both Connecticut and Georgia on PrEP uptake. These findings provide important direction for geographic inequities on PrEP use, but also a pragmatic method for co-creating and re-imagining place-health research. These results also offer an avenue to leverage the dynamic nuance of activity spaces as indicators to inform structural interventions for PrEP that are more equitable for GBSMM in small cities and towns in the U.S.