PrEP Usage in U.S. Hits Historic Highs, But Disparities Persist
By Robert Kessler
The Centers for Disease Control and Prevention (CDC) has released preliminary data showing a continued increase in PrEP uptake in 2022. While the overall trend of expanded access to the HIV prevention tool may in part account for fewer reported infections overall, the numbers also show widening inequities between who can and cannot access the medication—and who remains at risk for HIV unnecessarily.
Pre-exposure prophylaxis (PrEP) is a biomedical intervention that is more than 99% effective at preventing sexual transmission of HIV. (Truvada for PrEP is also indicated for preventing transmission of HIV via injection drug use.) It is an important tool in bringing an end to the HIV pandemic, but, more than 10 years after FDA approval, many people who could benefit are still not able to access PrEP.
The CDC estimates that about 1.2 million Americans would benefit from a PrEP prescription. Of those, 36% were accessing PrEP in 2022. That is a record high and the first time more than one-third of those who stand to benefit from using PrEP were prescribed it, up from just 23% in 2019.
A closer look at the numbers, however, shows stark divisions along racial and gendered lines.
Nearly all white Americans (94%) who could benefit received a prescription for PrEP last year. But only 24% of their Latine and 13% of their Black counterparts accessed PrEP, despite their disproportionate need. For example, 40% of new HIV infections in the U.S. occur in Black people, despite accounting for only 14% of the population. Additionally, gay and bisexual men accounted for the most new HIV infections in 2021, and the majority of them were among Black or Hispanic/Latine individuals.
CDC data show that racial divisions in PrEP access are only widening: While the number of white Americans on PrEP has grown by 34% in three years, growth among Black Americans over the same time period is only 5%.
A gender gap exists for PrEP users, as well. (Note that the CDC only tracks PrEP use according to sex assigned at birth and not current gender identity, so data related to transgender and other gender nonconforming people are not available.) Among men who could benefit from PrEP, 41% are using the medication, but only 15% of women are. While only one-fifth of new HIV infections in 2021 were among women, Black women accounted for over half of them.
So why the inequities?
While most insurance and Medicaid programs cover PrEP, the reimbursement process can sometimes be lengthy and difficult, which presents a significant burden to access. Additionally, experts have suggested that physicians need to be better educated on which of their patients could benefit from PrEP.
Robert Kessler is amfAR’s program communications manager.