Factors Associated With PrEP Utilization and Access in the United States

HIV pre-exposure prophylaxis (PrEP) is a cornerstone of the Ending the HIV Epidemic plan. We evaluated sociodemographic factors associated with PrEP use in jurisdictions with high HIV diagnosis rates between the initial years of PrEP rollout in the U.S. Data were abstracted from AIDSVu, U.S. Census Bureau, and Massachusetts Institute of Technology Election Lab data for years 2012-2019. Linear mixed methods modeling was used to correlate county-level PrEP rates and correlational analysis for state-level PrEP rates (PrEP use per 100,000 persons) with year, HIV diagnoses, income, insurance coverage, proportion of Democratic votes for president in 2020, race, and geographic location. Sociodemographic factors such as income, race, and political affiliation were significantly associated with county- and state-level PrEP use. Further research to understand policy differences that lead to inequitable provision of PrEP is needed.