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10 Years After HIV PrEP Approval, Uptake Lowest Among Highest Risk Groups

Expanding Medicaid and reducing stigma can bolster equitable HIV PrEP access, Dr. Patrick Sullivan says.

Pre-exposure prophylaxis (PrEP), preventative medication that can reduce the risk of contracting HIV by over 99%, is the single greatest reducer of HIV infection.

Now, a decade past the initial approval of PrEP in 2012, Emory University professor Dr. Patrick Sullivan is studying whether the populations most at risk of HIV infection are utilizing PrEP.

In research conducted by AIDSVu and presented this week at the 24th International AIDS Conference (AIDS 2022), Sullivan and his team found gaping, systemic PrEP usage disparities in the US.

Sullivan originally came into the medical field as a veterinarian, but after completing an outbreak investigation training through the Centers for Disease Control and Prevention (CDC), Sullivan found he “liked the problem-solving aspect of public health epidemiology.”

For the past 20 years, he has been invested in HIV prevention research, specifically focusing on HIV infection inequities.

When it comes to PrEP, Sullivan says, “We’re really making sure that there’s adequate access and use, and that’s high in the populations where risk is high.”

PrEP use has grown exponentially, but Sullivan and his team found statistically significant disparities between the populations most at risk for HIV infection and the populations taking PrEP.

“Black Americans represented 42% of all new HIV diagnoses,” Sullivan said, but only 14% of PrEP users are Black Americans. Similarly, Hispanic Americans made up 27% of new HIV diagnoses but only 17% of PrEP users.

In addition to calculating what they termed the “PrEP-to-need ratio” by race and ethnicity, Sullivan and his team determined PrEP uptake by US region as well. They found that equitable PrEP use was highest in the US Northeast, and lowest in the South.

Sullivan emphasizes one “stark” finding was, “As PrEP use has increased, year over year, which is what we wanna see, we also see the inequity increasing.”

“Meaning,” he explained, “the increases that happen year over year are mostly happening in White Americans, and we know that the epidemic and new diagnoses are mostly made up of Black and Brown people.”

Watch this exclusive Contagion video interview with Dr. Sullivan to hear him break down these HIV PrEP disparities, why they persist, and what must be done to end them.