BACKGROUND Pre-exposure prophylaxis (PrEP) is an effective HIV prevention modality, but utilization is suboptimal, especially within rural areas and among sexual and gender minority (SGM) individuals who live in these areas.

OBJECTIVES To explore healthcare access and PrEP utilization among a diverse sample of rural residents.

METHODS From May 25-July 2, 2021 the ruralHarmony program utilized REDCap to survey residents aged 18+ years across rural, southern IL. Measures included demographics, healthcare access and use, and PrEP experience.

RESULTS 400 participants from 21 counties completed surveys. Most reported a cisgender gender modality (94.3%); non-heterosexual orientation (35.8% gay/lesbian, 13.3% bisexual, 14.8% pansexual); and White race (79.3%; with 12.3% Black, and 7.8% Hispanic). Mean age was 28.3 years.

Of 238 individuals reporting a non-heterosexual sexual identity, 76.9% were currently insured and 95.4% had a current healthcare provider. However, only 19 (8.0%) had ever received a PrEP recommendation and 16 (6.7%) had a current prescription. Among the 19 with a recommendation, the majority reported difficulty finding a physician to discuss/prescribe PrEP (73.7%), and difficulty filling prescriptions due to time/distance and affordability (both 77.8%).

Logistic regression examining PrEP recommendation found no significant associations of race, gender identity, sexual orientation, insurance type, current PC provider (all categorical) or age (sig=0.170).

CONCLUSION The great majority of rural SGM do not report ever receiving a PrEP recommendation, but 84.2% of those with a recommendation have a current prescription. It is imperative that rural clinicians be willing to discuss and prescribe PrEP, and widely advertise that they do so.