HEALTH
BY DANIEL HIRSCH (AS SEEN AT DAPHEALTH.ORG)
FIGHTING PERSISTENT DISPARITIES IN PREP USAGE ince its arrival in 2012, pre-exposure prophylaxis (PrEP) has revolutionized the fight to stop the spread of HIV. Its usage in the U.S. has climbed steadily over the last decade — from around 9,000 users to over 300,000, according to Center for Disease Control (CDC) data. However, a grim reality sadly persists. Huge disparities exist in terms of who is accessing PrEP, and which communities are benefiting from the lowered HIV infection rates the 99% effective drug can bring. “Disparities in PrEP follow the same disparities in sexual health in the general population,” says DAP Health PrEP Navigation Manager Andrew Glorioso. PrEP usage rates reveal deep-seated inequities along racial lines. In a 2024 study in the journal Health Equity, research from 2019 to 2022 that analyzed a pool of people deemed at high risk for contracting HIV found that among White people, 74% were accessing PrEP. In this same group, the coverage rate for Latinos was only 18.9%, and for Black people, just 10.3%. Incidence rates of HIV infections are much higher in these non-White popu-
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lations. According to CDC data, Black people make up 42% of HIV diagnoses, while Latinos make up 35%, even though they only represent 13% and 19% of the general population, respectively. Disparities like these make Glorioso’s job vital. The PrEP Navigation team he manages helps people who don’t otherwise have — but would benefit from — access to PrEP. “We can get PrEP for 100% of individuals who come to our door,” says Glorioso, adding that his team can get patients a month of generic oral PrEP (brand name, Truvada) for as little as no cost, or for no more than $9, depending on insurance status. “So, it’s not a disparity of access to PrEP, but a disparity in education,” maintains Glorioso. “But in order to be able to
educate people about PrEP, we must be able to talk openly about sex. Stigma related to the perception that going to the sexual wellness clinic means you’ve been a bad person trickles down to PrEP.” The Health Equity journal study similarly cites cultural attitudes as a key factor in who is accessing PrEP. Historically marginalized communities may mistrust medical institutions — which themselves might have a problematic legacy of institutional racism — and choose to not adopt novel medical interventions like PrEP. Pervasive homophobia, transphobia, and biphobia may also inhibit patients from talking to their doctors about HIV prevention. Compounding this is the fact that many doctors are either not