Location location location: an exploration of disparities in access to publicly listed pre-exposure prophylaxis clinics in the United States

Ann Epidemiol. 2018 Dec;28(12):858-864. doi: 10.1016/j.annepidem.2018.05.006. Epub 2018 May 26.

Abstract

Purpose: HIV pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV transmission. Finding a PrEP provider, however, can be a barrier to accessing care. This study explores the distribution of publicly listed PrEP-providing clinics in the United States.

Methods: Data regarding 2094 PrEP-providing clinics come from PrEP Locator, a national database of PrEP-providing clinics. We compared the distribution of these PrEP clinics to the distribution of new HIV diagnoses within various geographical areas and by key populations.

Results: Most (43/50) states had less than one PrEP-providing clinic per 100,000 population. Among states, the median was two clinics per 1000 PrEP-eligible men who have sex with men. Differences between disease burden and service provision were seen for counties with higher proportions of their residents living in poverty, lacking health insurance, identifying as African American, or identifying as Hispanic/Latino. The Southern region accounted for over half of all new HIV diagnoses but only one-quarter of PrEP-providing clinics.

Conclusions: The current number of PrEP-providing clinics is not sufficient to meet needs. In addition, PrEP-providing clinics are unevenly distributed compared to disease burden, with poor coverage in the Southern divisions and areas with higher poverty, uninsured, and larger minority populations. PrEP services should be expanded and targeted to address disparities.

Keywords: HIV; Pre-exposure prophylaxis; Primary prevention.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • African Americans / statistics & numerical data
  • African Continental Ancestry Group / statistics & numerical data
  • Ambulatory Care Facilities / statistics & numerical data*
  • Anti-HIV Agents / therapeutic use
  • Female
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control*
  • Health Services Accessibility / statistics & numerical data*
  • Healthcare Disparities*
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Insurance, Health
  • Male
  • Poverty
  • Pre-Exposure Prophylaxis / methods
  • Pre-Exposure Prophylaxis / statistics & numerical data*
  • Residence Characteristics
  • United States / epidemiology
  • Young Adult

Substances

  • Anti-HIV Agents