<p>HIV pre-exposure prophylaxis (PrEP) prevents HIV transmission. However, PrEP remains underutilized among people who inject drugs (PWID), even when clinically indicated. Here, we assess changes in PrEP awareness, access, and use in 2018 and 2022 and factors associated with PrEP awareness in 2022. We analyzed a sample of PWID not living with HIV with an indication for PrEP based on National HIV Behavioral Surveillance (NHBS) in Portland, Oregon during the 2018 and 2022 survey cycles. We compared PrEP awareness, access, and use in 2018 and 2022 with χ². Using 2018 and 2022 data, we compared PrEP awareness between the two years with a Poisson regression. Using 2022 data, we assessed factors associated with PrEP awareness. Compared to 2018, PrEP awareness was higher in 2022 (33% vs 17%, p &lt; 0.001, aPR = 1.24, 95% CI = 1.14–1.36). There were no significant differences in PrEP access or use between 2018 to 2022. In the 2022 sample, PrEP awareness was higher among those with Hispanic ethnicity compared to white, non-Hispanic PWID (aPR = 2.18, 95% CI = 1.21–3.90) and previous drug treatment (aPR = 1.79, 95% CI = 1.20–2.69). Although PrEP awareness was higher in 2022 than 2018, PrEP access and use were unchanged and remained rare. PrEP use among PWID remains insufficient to meet national Ending the HIV Epidemic goals.</p>