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Trends in PrEP Inequity by Race and Census
Region, United States, 2012-2021
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AIDS 2022 July 29-Aug 1 Montreal
Patrick Sullivan, Shamaya Whitby, Palmer Hipp, Marta Juhasz, Stephanie DuBose, Pema McGuinness, Dawn K. Smith
* PrEP-to-Need Ratio (PNR) is the ratio of the number of PrEP users in 2021 to the number of people newly diagnosed with HIV in 2019. It is a measurement for whether PrEP use appropriately reflects the need for HIV prevention. A lower PNR indicates more unmet need.
What These Data Tell Us https://aidsvu.org/prep-use-race-ethnicity-launch-22/
(PrEP use data is from 2021, and new diagnoses data is from 2020, unless otherwise noted.
Due to the COVID-19 pandemic, all data from 2020 should be interpreted with caution)
PrEP Use by Race/Ethnicity
• Black people represented 14% of PrEP users, but 42% of new HIV diagnoses.
• Hispanic/Latinx people represented 17% of PrEP users and 27% of new HIV diagnoses.
• White people represented 65% of PrEP users and 26% of new HIV diagnoses.
• Regionally, Black people made up 52% of new HIV diagnoses in the South, but only 21% of PrEP users in the South; in the Midwest, Black people made up 48% of new HIV diagnoses, but only 12% of PrEP users.
• Of the 7 states with the greatest unmet need for PrEP among Black people, three were in the South (Arkansas, Mississippi, and Alabama) and three were in the Midwest (North Dakota, South Dakota, and Iowa). These states have a PrEP-to-Need Ratio (PNR) of less than 2 (i.e., fewer than 2 PrEP users for every new HIV diagnosis)*.
• In the West, Hispanic/Latinx people represented 43% of new HIV diagnoses but only represented 22% of all PrEP users.
Overall PrEP Use
• The number of PrEP users in the U.S. increased by 23% from 2020 to 2021, continuing a trend of consistent growth in PrEP use since 2012.
• Although PrEP use has increased steadily every year since 2012, there was a much lower rate of increase in 2020 of only 11% from 2019. This lower pace of growth occurred during the COVID-19 pandemic.
• The South accounted for 52% of HIV diagnoses but only accounted for 39% of PrEP users.
• In 2021, states that had expanded their Medicaid programs had rates of PrEP use that were 1.5X higher than states that did not expand Medicaid.
• Among all PrEP users in the U.S., 92% were male and only 8% were female, despite the fact that women comprised 18% of new HIV diagnoses.
• Teenagers and young adults (aged 13-24 years) had the greatest unmet need for PrEP among all age groups, with a PNR of 6*accounting for 20% of new HIV diagnoses but only 13% of PrEP users.
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