Use of pre-exposure prophylaxis (PrEP) is rising overall, but disparities in need and lack of equitable access remain a challenge.

 

Using a metric called the PrEP-to-need ratio—defined as the number of individuals using PrEP each year divided by the number of new HIV diagnoses the previous year—one recent analysis showed that men living in predominantly white neighborhoods or covered by commercial insurance have ready access to PrEP and low unmet need. In contrast, despite moderate increases in PrEP use from 2019 to 2023, men living in mainly Black or Latino neighborhoods and those covered by Medicaid still have a high level of unmet need.

 

Targeted interventions can help improve PrEP access for specific populations. In another study, researchers from the HIV Prevention Trials Network assessed an integrated strategy to increase daily oral PrEP use among transgender women in four U.S. cities and Rio de Janeiro. Women in one group were offered gender-affirming hormone therapy, PrEP pills and peer health navigation sessions at a single site, while the other group received case management and referrals for hormone therapy. In both groups, PrEP uptake rose from 11% at the start of the study to nearly 90%, and half achieved good adherence.

 

“Transgender women have one of the highest HIV prevalence of any population yet continue to struggle to access and adhere to PrEP,” says study investigator Wafaa El-Sadr, MD, MPH, of Columbia University. “Tailoring strategies to address the unique needs of this population is critical to addressing this challenge.”