ABSTRACT
Background:
PrEP was approved for
HIV prevention in the US in 2012; uptake has been slow. We describe relative
equity with the PrEP
Equity Ratio (PER), a ratio of PrEP-to-Need Ratios (PnRs).
Methods:
We used commercial
pharmacy data to enumerate PrEP users by
race and
ethnicity,
sex, and US
Census region from 2012 to 2021. We
report annual
race and
ethnicity-,
sex-, and region-specific rates of PrEP use and PnR, a
metric of PrEP
equity, to assess
trends.
Findings:
PrEP use increased for Black,
Hispanic and
White Americans from 2012 to 2021. By 2021, the rate of PrEP use per
population was
similar in Black and
White populations but slightly lower among
Hispanic populations. PnR increased from 2012 to 2021 for all
races and ethnicities and regions; levels of PrEP use were inconsistent across regions and highly inequitable by
race,
ethnicity, and
sex. In all regions, PnR was highest for
White and lowest for
Black people. Inequity in PrEP use by
race and
ethnicity, as measured by the PER, grew early after availability of PrEP and persisted at a level substantially below equitable PrEP use.
Interpretation:
From 2012 to 2021, PrEP use increased among Americans, but PrEP
equity for Black and
Hispanic Americans decreased. The US South lagged all regions in equitable PrEP use. Improved
equity in PrEP use
will be not only just, but also impactful on the US
HIV epidemic;
persons most at-
risk of acquiring
HIV should have the highest levels of access to PrEP. Prevention programs should be guided by PrEP
equity, not PrEP equality.
Funding:
National Institutes of Health, Gilead
Sciences.