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Participants in the South and Midwest were less likely to speak to a provider about PrEP or initiate PrEP. Baseline characteristics associated with lower odds of PrEP initiation at year 1 include not having a college degree; earning $20,000/year; not having health insurance; having very low food security; and not having a primary care doctor. Lack of health care access is a major barrier to PrEP implementation and may exacerbate disparities in PrEP uptake across geographic regions. Lack of health care access is a major barrier to Pr