PrEP is for Everyone

Introduced in 2012, PrEP has come a long way, from a daily oral single-pill regimen of Truvada (Gilead Sciences) that required patients to adhere to a relatively strict dose schedule to the first long-acting injectable prevention medication, Apretude (ViiV). Both the oral and injection-based regimens provide prevention rates of up to 99% when taken consistently and correctly. Like with most things, disparities exist, especially among Black and Hispanic Americans and Women

While these medications provide significantly more efficacy in prevention against HIV than condoms, uptake in the early years of availability was largely confined to affluent (and often White) gay men living in urban areas (Hammack et al., 2018). These low uptake numbers indicated the need for better, more targeted advertising and educational campaigns. That need continues today.

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Despite the significant progress made over the past 20 years in reducing the number of new HIV infections in the United States, many patient populations still face significant disparities related to the disease, including the ability to access affordable HIV prevention, testing, and treatment.

In 2022, the most recent year for available HIV diagnosis and prevalence data, nearly 38,000 people living in the United States were diagnosed with HIV at a rate of 13.3 (per 100,000), with the highest diagnosis rates occurring in Black Americans (r = 41.0), patients aged 25-34 (r = 30.9), Hispanic/Latine Americans (r = 23.8), and Multiracial Americans (r = 23.5; Centers for Disease Control and Prevention, 2024).

HIV has a long history of being considered an “urban” disease, in no small part because of the epidemic’s beginnings in America’s largest metropolitan areas in the 1980s. Over time, epidemiology and better HIV education campaigns have helped both policymakers and the general population understand that HIV exists everywhere.

Despite this progress, testing, surveillance, and reporting for HIV outside of larger population centers continue to languish. While county-level diagnosis rates exist, they are largely inadequate when examining HIV diagnosis rates for the simple reason that most people living in rural counties must travel to receive HIV testing and diagnostic services. Furthermore, despite improvements in HIV case data collection and reporting, many organizations and providers who provide HIV testing services fail to link HIV diagnoses to patients’ counties of residence. This may contribute to rural counties reporting lower, suppressed, or no HIV diagnoses when there are, in fact, people now living with HIV in those counties. When examining the 2291 counties and independent Virginia cities designated as “rural” by the Federal Office of Rural Health Policy, the HIV incidence rate in 2022 was 5.3 for those counties. This is likely due to suppressed rates and inaccurately attributed diagnoses.

These disparities in HIV diagnosis have remained largely consistent over the past decade. Yet, both national PrEP utilization numbers (n = 591,475) and rates (r = 206.0) for 2024 indicate that the vast majority of PrEP users are overwhelmingly male (90.2%; r = 381.0) and White (62.9%; r = 218.0).

This is not to say, however, that PrEP utilization rates for Black and Hispanic/Latine Americans have not improved; to the contrary, the most recent data indicate that utilization percentages for both Black and Hispanic patients are roughly on par with national population percentages (Black PrEP Users n = 14.5%; Hispanic PrEP Users n = 17.8%).

We can, however, do better.

More accurately, we can reach more people who need PrEP to prevent the acquisition of HIV by reaching beyond major population centers. The development and release of long-acting injectable PrEP may allow patients who are HR/HT the opportunity to take advantage of more accessible options to prevent the acquisition of HIV.

For much of PrEP’s history on the market, patients have been turned away as being poor candidates because of reasons that may be beyond their control, including the distance to providers, geographic barriers, housing insecurity, homelessness, mental health issues, and substance use disorders. With the availability newer delivery modalities, including twice-yearly injections, we have the opportunity to increase PrEP uptake in patients who face increased risk of acquiring HIV, but have been unable to make the available options work for them.

PlusInc knows that patient populations are not monoliths; that patient experiences can vary widely, even within specific demographic groups. This requires organizations to work in collaboration and coordination to reach those most at risk of acquiring HIV to provide them with scientifically accurate and easy-to-understand informational and educational campaigns that meet patients where they are likely to see and absorb them. PlusInc will launch a national public awareness campaign in the coming weeks to address these health disparities, called “PrEP is for Everyone.”