Myers JJ, et al. - Considering the possible preventive effect of pre-exposure prophylaxis (PrEP) for young men of color who have sex with men, young men who have sex with men (aged 18–29 years) were offered HIV and sexually transmitted infection testing, prevention counseling, PrEP, and sexually transmitted infection treatment and postexposure prophylaxis when appropriate in the Connecting Resources for Urban Sexual Health (CRUSH) demonstration project. Adherence and factors influencing it are reported in this work. Initially, participants showed high adherence at protective levels with 87% demonstrating levels consistent with at least four doses per week at week 4, vs 77% at the 48-week follow-up. Adherence was significantly lower in correlation with African American race, exposure to violence, and having survival needs. The findings emphasize considering differences in life experiences in interventions, addressing especially structural challenges facing young African American men.