HIV Preexposure Prophylaxis Initiation at a Large Community Clinic: Differences Between Eligibility, Awareness, and Uptake

Am J Public Health. 2018 Oct;108(10):1408-1417. doi: 10.2105/AJPH.2018.304623. Epub 2018 Aug 23.


Objectives: To characterize uptake of HIV preexposure prophylaxis (PrEP) in a community setting and to identify disparities in PrEP use by demographic and behavioral factors associated with increased HIV risk.

Methods: We conducted a cross-sectional study of 19 587 men who have sex with men and transgender people visiting a Los Angeles, California, clinic specializing in lesbian, gay, bisexual, and transgender care between August 2015 and February 2018 by using clinical care data.

Results: Seventy percent of patients met PrEP eligibility criteria, while 10% reported PrEP use. Using sex drugs, reporting both condomless anal intercourse and recent sexually transmitted infection, older age, and higher education level were associated with higher odds of PrEP use given eligibility. Latino or Asian race/ethnicity and bisexual orientation were associated with lower odds of PrEP use given eligibility. Higher odds of perceived need were associated with demographic risk factors but PrEP use was not similarly elevated.

Conclusions: Discrepancies between PrEP eligibility, perceived need, and use reveal opportunities to improve PrEP delivery in community settings. Public Health Implications. Efforts are needed to facilitate PrEP uptake in populations with highest HIV incidence.

MeSH terms

  • Adolescent
  • Adult
  • Ambulatory Care Facilities
  • Anti-HIV Agents / administration & dosage*
  • Awareness*
  • Cross-Sectional Studies
  • Female
  • HIV Infections / prevention & control*
  • Homosexuality, Male
  • Humans
  • Los Angeles
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care*
  • Pre-Exposure Prophylaxis*
  • Risk Factors
  • Sexual and Gender Minorities
  • Transgender Persons


  • Anti-HIV Agents