Another Instance in which Minorities Lag on a Key Prevention Tool: PrEP

By Dennis Archambault

Of the most promising prevention tools in addressing the AIDS epidemic is the development of the drug pre-exposure prophylaxis or “PrEP.” Yet, like other forms of health inequity, African Americans and other minorities are not getting the drug as much as white people – yet minorities are contracting the diseases in a greater percentage than whites. The greatest concern is that young people are the least exposed to the drug yet have the highest incidence rate of all populations. Key findings include:

• 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.
• Teenagers and young adults (aged 13-24 years) had the greatest unmet need for PrEP among all age groups.

These findings were released on July 29 by AIDSVu, a data service that follows the AIDS epidemic through data and other resources. They were presented at the recent annual International AIDS Conference.

“HIV prevention programs should be guided by PrEP use equity – the use of PrEP relative to the impact of the HIV epidemic on that group. Today’s data shows that we have a long way to go,” said Patrick Sullivan, DVM, PhD, Professor of Epidemiology at Emory University’s Rollins School of Public Health and Principal Scientist for AIDSVu. “It is important that data do not live in a vacuum and that the insights we glean from research are translated into policy and action. Visualizing PrEP use data on AIDSVu draws attention to underserved people and geographic regions and helps prevention programs better allocate resources to ensure PrEP reaches the people and communities with the greatest unmet need for PrEP.”

Dr. Sullivan blamed the gap on economic and other disparities that contribute to health care inequities along racial lines across the country, in a Detroit News interview. He noted the drug’s cost can make it out-of-reach for people without health insurance, and noted the gap is greatest in the South, and in states that have not expanded Medicaid under the Affordable Care Act. Michigan is one of the states with expanded Medicaid, known as Healthy Michigan Plan.

People with insurance to cover the cost of the drug can still find the treatment inaccessible due to lack of transportation to clinics, their employment situation or other issues related to economic status, Dr. Sullivan said. He cited transportation issues, as well as the social stigma of identifying as someone with AIDS or at risk of AIDS. However, he said that telehealth offers a promising method of overcoming cost, transportation, and social barriers to care.

 Dennis Archambault is vice president of Public Affairs for Authority Health.