Assessment of Attitudes, Barriers, and Facilitators of Pre-exposure Prophylaxis (PrEP) Use Among Individuals Involved in the Criminal Legal System in the Southern U.S.

This qualitative study explores barriers to and facilitators of pre-exposure prophylaxis (PrEP) use among individuals involved in the criminal legal system (CLS) in the Southern U.S. Through in-depth interviews with 72 participants on probation or parole across Florida, Kentucky, and North Carolina, we identified five key themes: (1) depersonalization of HIV risk, where participants acknowledged PrEP's value but excluded themselves as candidates; (2) stigma, including internalized, interpersonal, and structural barriers; (3) financial and insurance constraints, exacerbated in non-Medicaid expansion states; (4) medical mistrust stemming from negative carceral health care experiences; and (5) the unexpected role of research participation as a primary source of PrEP education. Findings align with and extend existing literature on marginalized populations, highlighting the need for tailored interventions addressing systemic, institutional, and community-level barriers. This study underscores the urgency of centering lived experience and policy innovation to improve PrEP access for this high-risk population.