Disparities in HIV Pre-Exposure Prophylaxis Uptake Worsening at the State Level in the US

Open bottle of prescription PrEP Pills for Pre-Exposure Prophylaxis to help protect people from HIV.
The researchers examined trends in PrEP uptake at the state and regional level from 2014 to 2018 and assessed whether early adoption of PrEP had offered long-term gains.

The trend of states that were late adopters of pre-exposure HIV prophylaxis (PrEP) uptake is worsening compared with the trend of states that were early adopters. These findings from a retrospective analysis were published in Open Forum Infectious Diseases.

Researchers at the University of Virginia analyzed state-level PrEP uptake between 2014 and 2018 using data from AidsVu.org. Uptake was defined as the number of individuals who received a prescription divided by the number who had an indication for PrEP use (injection drug use in previous 6 months, unprotected sex with individuals with HIV or unknown status, or sexually transmitted infection in previous 6 months).

The Northeastern states had the greatest increase in PrEP uptake (16.6%) followed by the Midwest (9.2%), but poor uptake was observed in the West (7.1%) and the South (7.0%). Every year, uptake increased by 1.18% (95% CI, 0.89% to 1.46%) for every 5% increase in baseline use.

In 2014, the highest uptake occurred in Massachusetts (8.3%) and the lowest in Wyoming (0.4%). In 2018, the highest uptake was in New York (29.7%) and the lowest in Wyoming (2.4%). Idaho, Montana, and Wyoming were consistently among the 5 states with the lowest uptake.

By 2018, states that were early adopters had increased uptake of 12% over late adopters. Only 2 states (Oklahoma and Tennessee) transitioned from being low-uptake states to high-uptake states.

This study may have been limited by sourcing data from AidsVu.org, which contains information about PrEP prescriptions. The investigators could not assess what proportion of individuals who were given a prescription filled or took their PrEP.

The study authors concluded disparities in PrEP uptake between early and late adopting states was worsening in the US. To end the HIV epidemic, federal and state policies must target PrEP distribution among populations at high risk for infection.

Additional research is needed to assess successful methods for increasing PrEP uptake.

Disclosure: One study author declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Powers SD, McQuade ETR, Killelea A, Horn T, McManus KA. Worsening disparities in state-level uptake of HIV pre-exposure prophylaxis from 2014-2018. Open Forum Infect Dis. Published online June 4, 2021. doi:10.1093/ofid/ofab293