AIDSVu Releases New Data Highlighting Inequities in PrEP Use among Black and Hispanic People

AIDSVu has released PrEP use data and maps by race/ethnicity at the state-level for 2022, showing that while PrEP use has continued to increase on average by 56% each year since its approval in 2012, significant inequities remain in PrEP use among Black and Hispanic people and in the Southern region of the country.

These data reveal the importance of looking at PrEP use through a health equity lens. In order to be effective, programs should be driven by the goal of increasing PrEP use among populations with the greatest unmet need for PrEP. The data available on AIDSVu can help inform policies and programs to ensure that communities that are disproportionately impacted by HIV are aware of and able to access PrEP.

PrEP, or pre-exposure prophylaxis, is a medicine that reduces an individual’s chances of getting HIV. When taken as prescribed, PrEP is highly effective for preventing HIV. The Centers for Disease Control and Prevention (CDC) has estimated that approximately 1.2 million people could benefit from comprehensive HIV prevention strategies, including PrEP.

Gender and Racial/Ethnic Disparities

Data on AIDSVu show significant disparities in PrEP use by racial/ethnic group and gender. In 2022, Black people represented 14% of PrEP users, but 42% of new HIV diagnoses in 2021. 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. This indicates a high unmet need for PrEP in both Black people and women, and likely points to an unmet need in Black women as well.

The significant racial/ethnic disparities in PrEP use persist when we look at the South. In 2021, Black people represented 48% of new HIV diagnoses in the South, but only accounted for 21% of PrEP users in the region in 2022. Comparing PrEP use by race to new HIV diagnoses (also known as the PrEP-to-Need Ratio) highlights this further. In the South, there were 27 white PrEP users for every new HIV diagnosis among white people. In comparison, there were only 4 Black PrEP users for every new HIV diagnosis among Black people—meaning there is a significant unmet need for PrEP among Black people in the South.

Regional Disparities

While overall PrEP use has increased in recent years, AIDSVu’s 2022 data highlight significant geographic disparities. For every new HIV diagnosis in the Northeast, there were 22 people on PrEP. However, in the South, there were only 10 people on PrEP for every new HIV diagnosis, indicating an unmet need for PrEP compared to other regions.

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What These Data Tell Us

AIDSVu’s latest data displays PrEP use and PrEP-to-Need Ratio (PNR) from 2012 through 2022 down to the county-level, stratified by age and sex. At the state-level, data is also stratified by race/ethnicity.

(PrEP use data is from 2022, and new diagnoses data is from 2021, unless otherwise noted.)

Overall PrEP Use

The number of PrEP users in the U.S. increased by 20% from 2021 to 2022, continuing a trend of consistent growth in PrEP use since 2012.
The South accounted for 52% of HIV diagnoses but only accounted for 38% of PrEP users.
In 2022, states that had expanded Medicaid programs had an average PrEP use rate that was 1.4X higher compared with states that have not expanded Medicaid.

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 64% of PrEP users and 26% of new HIV diagnoses.
Regionally, Black people made up 48% 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.

In the South, there were 27 white PrEP users for every new HIV diagnosis among white people. In comparison, there were only 4 Black PrEP users for every new HIV diagnosis among Black people.
Of the 5 states with the greatest unmet need for PrEP (Puerto Rico, Mississippi, South Carolina, Alabama, and West Virginia), 4 were in the Southern region of the United States.
In the West, Hispanic/Latinx people represented 46% of new HIV diagnoses but only represented 23% of all PrEP users.

PrEP Use by Sex

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.

PrEP Use by Age

Teenagers and young adults (aged 13-24 years) had the greatest unmet need for PrEP among all age groups, with a PNR of 9. That means that for every person in that age group diagnosed with HIV, there were only 9 people using PrEP.
64% of all PrEP users were between 25 and 44 years old.
The rate of PrEP use per 100,000 people was highest in the 25-34 age group (378) and lowest in the 55+ age group (46).

* PrEP-to-Need Ratio (PNR) is the ratio of the number of PrEP users in 2022 to the number of people newly diagnosed with HIV in 2020. It is a measurement for whether PrEP use appropriately reflects the need for HIV prevention. A lower PNR indicates more unmet need

More PrEP Data & Resources on AIDSVu

Additional PrEP resources on AIDSVu include a Deeper Look: PrEP page providing further insights on AIDSVu’s PrEP use and PNR data, downloadable infographics and data sets, national, regional, state, county, and city profiles, and blogs by HIV experts. AIDSVu also features a PrEP Locator, a national directory of public and private practice providers of PrEP across the U.S. AIDSVu users can find local PrEP providers near them with this tool or overlay service locations on top of AIDSVu’s PrEP use maps.

PrEP Use and HIV Testing

AIDSVu is releasing this updated data in advance of National HIV Testing Day this year to recognize the importance of including PrEP in a holistic HIV testing and prevention strategy. There is a growing movement among those working in HIV for a new kind of continuum that can be applied to everyone regardless of their HIV status, known as the HIV Status Neutral Prevention and Treatment Cycle.

This model is a whole person approach to HIV prevention and care that starts with HIV testing. If an individual is diagnosed with HIV, they move into the HIV care continuum and start treatment as soon as possible with the goal of achieving viral suppression. If the individual tests negative, they move into an HIV prevention continuum, which consists of understanding their risk of HIV exposure, learning about PrEP, and discussing HIV prevention strategies with a healthcare provider. Following those discussions, some people will start using PrEP, while others may be guided toward other prevention methods, such as condom use and more frequent HIV testing.

The goal of an HIV status-neutral cycle is to focus on the needs of the person through the provision of comprehensive services that meet people where they are regardless of their HIV status so that everyone can take next steps to protect themselves and their partners.

About the Data

The release of PrEP use data on AIDSVu was made possible through a data-sharing agreement, in which data were obtained from IQVIA Inc. with the support of Gilead Sciences, Inc., and compiled by researchers at the Rollins School of Public Health at Emory University.

The PrEP use data on AIDSVu represent a reliable and consistent estimate of the number of people who were prescribed TDF/FTC, TAF/FTC, or cabotegravir for PrEP in a calendar year from 2012 to 2022, excluding prescriptions for TDF/FTC, TAF/FTC, or cabotegravir that were made for other known indications, such as, post-exposure prophylaxis, chronic hepatitis B management, and treatment for HIV and other opportunistic infections. These individuals are referred to as “PrEP users.” AIDSVu’s PrEP use data are calculated to represent the estimated number of PrEP users in each county and state in the U.S. by year.

The IQVIA database contains anonymized individual-level prescription records collected electronically from U.S. retail pharmacies, traditional pharmacies, specialty mail-order pharmacies, long-term care (LTC) facilities, and “other” pharmacies (e.g., in-hospital pharmacies, HMO pharmacies). The IQVIA database uses national estimates of prescription fills to estimate PrEP prescriptions for the small percentage of U.S. prescriptions that are not tracked directly by IQVIA. The prescriptions database includes age and sex and was linked to a claims database to obtain diagnoses codes. Race/ethnicity was provided through a consumer database of self-reported information. Race/ethnicity data were available for about one in three PrEP users, and data summarized by race/ethnicity on AIDSVu are based on that subset of users.

Race/ethnicity data were available for about one in three PrEP users, and data summarized by race/ethnicity on AIDSVu are based on that subset of users.

AIDSVu continually strives to increase the granularity and usefulness of its publicly available data to inform local public health decision making. More information on PrEP use data sources, service locator, and more, see our Data Methods and FAQs.

The statements, findings, conclusions, views, and opinions contained and expressed on the AIDSVu website are based in part on data obtained under license from the following information service(s): LAAD Longitudinal Access and Adjudication Dataset HIV data, January 2012 – December 2022), IQVIA Inc. All Rights Reserved. The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IQVIA Inc. or any of its affiliated or subsidiary entities. Any analysis is independently arrived at by Emory University, on the basis of the data and other information.