Top 5 Takeaways

1. Low PrEP Awareness: Only 32.3% of heterosexually active adults in high HIV prevalence cities were aware of PrEP, and less than 1% used it.
2. Disparities Among Hispanic Individuals: Awareness was particularly low among Hispanic men (19.5%) and women (17.6%), and even lower among residents of Puerto Rico (5.8%).
3. Gender Differences: Men reported lower PrEP awareness (29.2%) compared to women (34.8%).
4. Impact of Insurance and Usual Source of Care: Uninsured participants (26.4%) and those without a usual source of care (29.1%) had lower awareness compared to their counterparts.
5. Need for Tailored Campaigns: Tailored and culturally competent PrEP campaigns, especially those targeting Hispanic persons and non-English speakers, are necessary to increase awareness and use.

Original Article Author and Citation

Corresponding Author

Amy R. Baugher, yda1@cdc.gov, 404-639-1956

Suggested Citation

Baugher AR, Trujillo L, Kanny D, et al. Racial, Ethnic, and Gender Disparities in Awareness of Preexposure Prophylaxis Among HIV-Negative Heterosexually Active Adults at Increased Risk for HIV Infection — 23 Urban Areas, United States, 2019. MMWR Morb Mortal Wkly Rep 2021;70:1635–1639. DOI: http://dx.doi.org/10.15585/mmwr.mm7047a3

Summary

In 2019, heterosexual sex accounted for 23% of new HIV diagnoses in the United States. Despite the effectiveness of preexposure prophylaxis (PrEP) in preventing HIV, awareness and use among heterosexually active adults in high-prevalence cities remain low. Only 32.3% were aware of PrEP, and less than 1% used it. Significant disparities were noted, particularly among Hispanic men and women and residents of Puerto Rico. Tailored PrEP campaigns and routine screening are essential to increase awareness and use among these groups.

Methods

The study analyzed data from the 2019 National HIV Behavioral Surveillance (NHBS) cycle, which included face-to-face interviews and HIV testing among low-income, heterosexually active adults in 23 urban areas with high HIV prevalence. PrEP awareness was defined as having ever heard of PrEP. The analysis used log-linked Poisson regression models with generalized estimating equations to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs).

Discussion

PrEP awareness among heterosexually active adults is low, particularly among Hispanic persons and those residing in Puerto Rico. Men reported lower awareness than women. Awareness was higher among Black persons, possibly due to targeted HIV prevention campaigns. Increasing PrEP awareness and use among heterosexual adults, particularly through culturally competent and tailored campaigns, is crucial to addressing HIV disparities.

Conclusion

Increasing PrEP awareness and use among heterosexual adults is essential to end the HIV epidemic in the United States. Tailored and culturally appropriate campaigns, routine screening, and patient-provider communication are necessary to achieve this goal. Efforts should focus on Hispanic persons, non-English speakers, and residents of Puerto Rico to mitigate existing disparities.

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