PrEP Access Steadily Increases, Yet Racial Health Disparities Persist

Pre-exposure prophylaxis (PrEP) access has increased over the years, but stark racial health disparities presented at the 24th International AIDS Conference yield concern that the HIV preventive medication doesn’t aid all racial groups similarly.

Proper PrEP adherence can reduce the risk of getting HIV from sex by about 99 percent, according to the Centers for Disease Control and Prevention (CDC) data.

A CDC estimation showed that approximately 1.2 million people could benefit from comprehensive HIV prevention strategies, including PrEP. And since PrEP was approved in 2012, usage has increased on average 56 percent each year, the researchers noted. But those gains haven’t been seen equally across all racial groups.

The study gathered data from over 124,000 PrEP users and divided them into groups by race and US Census region from 2012 to 2022. Using a PrEP-to-Need Ratio (PnR), researchers also evaluated a racial group’s PrEP use in relation to new HIV diagnoses.

While the growth in PrEP use advances, longstanding barriers hinder access among patients. As of 2021, there were only three Black PrEP users for every new HIV diagnosis.

Black people made up 14 percent of PrEP users but 42 percent of new HIV diagnoses. Similarly, Hispanic/Latinx people represented only 17 percent of PrEP users but 27 percent of new HIV diagnoses.

Meanwhile, researchers found that White people represented 65 percent of PrEP users, even though only 26 percent of new HIV diagnoses were White people.

“HIV prevention programs should be guided by PrEP use equity – the use of PrEP relative to the impact of the HIV epidemic on that group,” Patrick Sullivan, DVM, PhD, professor of Epidemiology at Emory University’s Rollins School of Public Health and principal scientist for AIDSVu, said in a press release. “Today’s data shows that we have a long way to go.”

Racial disparities were not the only iniquities noticed from the findings; researchers also found disparities based on geographical location.

The South experiences the greatest burden of HIV and deaths of any US region, but PrEP use was much lower for these patients. In 2021, Southern patients made up 52 percent of HIV diagnoses but only accounted for 39 percent of PrEP users.

Of those new diagnoses in the South, 52 percent are among Black people. Yet again, their needs are unmatched, as only 21 percent of PrEP users in the South are Black.

Of the seven states with the greatest unmet need for PrEP among Black people, three were in the South (Alabama, Arkansas, and Mississippi).

“It is important that data do not live in a vacuum and that the insights we glean from research are translated into policy and action,” Sullivan stated.

“Visualizing PrEP use data on AIDSVu draws attention to underserved people and geographic regions and helps prevention programs better allocate resources to ensure PrEP reaches the people and communities with the greatest unmet need for PrEP.”

In addition to policy change, Medicaid coverage can help boost PrEP use.

Researchers found that states with expanded Medicaid programs had rates of PrEP use that were 1.5 times higher than states without Medicaid expansion.

However, healthcare systems do not need to wait on policy change and expanded Medicaid coverage to increase PrEP uptake.

By working with their community and conducting patient outreach, providers can get patients on PrEP.