Pre-exposure prophylaxis (PrEP) is not benefiting all Americans equally, and the disparities are growing over time, according to new data presented at the 24th International AIDS Conference (available via interactive maps at AIDSVu.org).
Using commercial pharmacy data, Patrick Sullivan, DVM, PhD, of Emory University’s Rollins School of Public Health, and colleagues identified nearly 125,000 people who were prescribed PrEP between 2012 and 2021. The researchers estimated equity using a metric called the PrEP-to-need ratio, calculated by dividing the number of PrEP users by the number of new HIV diagnoses in a population group. This ratio is a more meaningful way to look at PrEP uptake relative to need than absolute numbers, according to Sullivan.
While PrEP uptake rose steeply among white Americans relative to their number of new HIV diagnoses, prescriptions for Black and Latino people aren’t meeting the need. White people made up 65% of PrEP users in 2021 but accounted for just 26% of new HIV diagnoses in 2020. In contrast, Black people made up 14% of PrEP users despite having 42% of new diagnoses, while Latino people made up 17% of PrEP users and 27% of new diagnoses.
Only 8% of PrEP users were women, who account for 18% of new HIV diagnoses. People in the South are also less likely to use PrEP—a cause for alarm, as the region has become the epicenter of the American HIV epidemic. In each region, a higher proportion of white people used PrEP relative to need. Disparities in PrEP use have
widened in all regions since its approval in 2012, but states that introduced PrEP assistance programs and expanded their Medicaid programs have seen more equitable rollouts.
“Prevention programs should be guided by PrEP equity metrics that take into account both use and need, not by PrEP equality metrics looking to get certain levels of coverage in all groups,” Sullivan says.