Barriers and facilitators to PrEP access, uptake and use in young people living in Queensland.

In January 2021, the Australian Pharmaceutical Benefits Scheme expanded its eligibility for subsidised access to pre-exposure prophylaxis (PrEP) to people under 18-years. In Australia, there is a limited understanding of how intrapersonal, interpersonal, social and structural factors impact access and use of PrEP among young people. Twenty-five semi-structured interviews were conducted with young people (16-24 years) living in Queensland, Australia. Participants identified as a range of gender (e.g., male, non-binary, trans male, trans female) and sexual identities (e.g., gay, queer, bisexual, asexual, lesbian). Most (80.0%, 20/25) reported having ever had sex. The majority reported awareness of PrEP (72.0%, 18/25) and eight (32.0%) currently/previously used PrEP. Inductive reflexive thematic analysis identified three themes describing how intrapersonal, interpersonal, social and structural factors influence PrEP access and use among young Queenslanders: (1) how a lack of knowledge and awareness, influenced by information provided by structural institutions and those within them, impacted PrEP uptake/use; (2) how the attitudes of others (peers/parents/healthcare providers) impacted use; (3) how the healthcare system creates barriers in access. Without a holistic consideration of the individual-, sociocultural-, and system factors impacting PrEP access, young people will be left behind in the race towards the elimination of HIV transmission in Australia.