Association of Race and Other Social Determinants of Health With HIV Pre-Exposure Prophylaxis Use: A County-Level Analysis Using the PrEP-to-Need Ratio

Abstract

Research is limited on the effect of racism and social determinants of health on HIV pre-exposure prophylaxis (PrEP) use. This study used the PrEP-to-Need Ratio (PNR), which measures PrEP prescriptions divided by HIV diagnoses in the county, to evaluate sufficient PrEP use. AIDSVu datasets were compared to county-level social determinants of health. Standardized regression coefficients (β) were compared to identify strongest associations with PNR. Overall, factors including percent African American and percent uninsured had negative correlations with PNR, whereas median household income and severe housing cost burden had positive associations. Stratifying for population size, percent African American, percent uninsured, and severe housing cost burden were significant for low population areas, whereas median household income, percent in poverty, percent uninsured, and percent African American were significant for large populations. To reduce PrEP disparities, public health must develop strategies to reach those most in need, especially historically disadvantaged communities.

Equity of PrEP uptake by race, ethnicity, sex and region in the United States in the first decade of PrEP: a population-based analysis

“…Here, we report trends in PrEP uptake overall and by US region, race and ethnicity, and sex in the US to describe overall changes in PrEP use in the first decade since PrEP regulatory approval. 10 , 11 , 12 , 13 , 14 , 15 , 16 We also present trends in race and ethnicity- and sex-specific PnRs using the PrEP Equity Ratio (PER) to characterise the extent to which PrEP use is equitable or inequitable.…”

PrEParing for the End of the HIV Epidemic—A Public Health Imperative

“…PNR serves as measurement of how PrEP use compares with the need for PrEP in a population. A 2022 analysis by Doherty et al highlighted geographic and racial and ethnic disparities in PrEP use. More worryingly, Doherty et al found that while already very wide, the racial and ethnic disparity in PNR has continued to widen in recent years.…”