Willingness-to-Pay for HIV Pre-Exposure Prophylaxis Among Men Who Have Sex with Men in the United States

Pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV, but out-of-pocket costs represent a critical barrier to uptake. We conducted an online survey from May 2020 to October 2021. Gay and bisexual men who have sex with men (GBMSM) in New England recruited through social networking apps were randomly assigned to view different monthly PrEP costs ($0-$105) and asked about their willingness to pay. Among 612 participants, each $10 increase in monthly costs was associated with a 6.0% point decrease in willingness to pay (p < 0.001). In logistic regression, each $1 increase reduced the odds of willingness to pay by 4% (odds ratio, 0.960; 95% CI, 0.952–0.968; p < 0.001). At $40 per month, 68% were willing to pay. Lower-income participants (<$75,000 annually) showed greater cost sensitivity (8.0% point decrease per $10 increase; p < 0.001). Participants at higher HIV acquisition risk (HIRI-MSM ≥ 10) were more willing to pay (β = 0.119; p = 0.001), as were those perceiving they definitely needed PrEP (β=-0.134 for those who may not or definitely did not need it; p = 0.005). These findings support policies that minimize or eliminate cost-sharing for PrEP to achieve HIV prevention goals.