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PrEP is approximately 99% effective in preventing HIV acquisition when taken as indicated.1 Yet, despite this efficacy, only approximately 25% of the estimated 1.2 million Americans with an indication for PrEP in 2020 were receiving it.2
Increasing PrEP uptake is among the key goals of the CDC’s Ending the HIV Epidemic in the U.S. initiative, which aims to get 50% of those who may benefit from PrEP using it by 2030.3 Although current uptake remains well below this target, there is evidence of incremental improvements. Uptake of PrEP was approximately 3% in 20153 and 22.5% in 2019.2 With additional effective PrEP products now available, and with greater recognition of barriers to care, we hope to continue to expand PrEP uptake to better reach those most at risk.
We know that some populations are less likely to be receiving PrEP despite having a PrEP indication. For example, PrEP coverage was 28.0% among at-risk men and 10.4% among at-risk women in 2020.2 Younger people aged 16-24 years have an uptake rate of 15.6%—compared with 27.4% in those aged 25-34 years and 30.3% in those aged 35-44 years—despite the known high risk of HIV acquisition among that subset. And although 43% of HIV diagnoses in the United States in 2020 were in Black or African American people and 26% were in Hispanic or Latinx people, PrEP uptake in 2020 was only 9.0% and 15.6%, respectively, in these populations. That contrasts with 65.7% PrEP uptake in White populations, who made up 26% of HIV diagnoses in this period.
Those most at risk of HIV infection may not recognize it. Culturally competent messaging and outreach are needed if we are to increase awareness of PrEP and its effectiveness among these underserved groups and to ensure that there are access points for PrEP within these communities.