Deeper Look: PrEP

What is Pre-exposure prophylaxis (PrEP)?

• Pre = before
• Exposure = coming into contact with HIV
• Prophylaxis = treatment to prevent an infection from happening

The PrEP utilization data on AIDSVu reveal a 52% average annual increase in persons using PrEP across the U.S. — including a 17% increase from 2022 to 2023. While these data point to significant growth in PrEP use nationwide, they also highlight important disparities in PrEP use across different sexes, races/ethnicities, age groups, geographic location, socioeconomic status, and access to care. In the United States, 36,126 people were diagnosed with HIV in 2021, underscoring the need to continue expanding the use of PrEP and other comprehensive HIV prevention strategies.

AIDSVu’s PrEP data, which provide a reliable and consistent metric for PrEP users in each county and state in the U.S. by year from 2012 to 2023, can be stratified by age and sex. State-level maps from 2021-2023 can additionally be stratified by race/ethnicity for Hispanic, Black, and white individuals. These data and maps offer important, comparative information and tools to public health officials, policymakers, and researchers to inform efforts to increase PrEP awareness and access where it is needed most. Please see the Data Methods page for additional information on the data set and its limitations.

What These Data Tell Us

(PrEP use data is from 2023, and new HIV diagnoses data is from 2022, unless otherwise noted.)

Overall PrEP Use:

• The number of PrEP users in the U.S. increased by 17% from 2022 to 2023, continuing a trend of consistent growth in PrEP use since 2012.
• Nationally, there are 13 PrEP users for every new HIV diagnosis. The PrEP-to-Need Ratio (PnR) has steadily increased from 10 in 2021, to 12 in 2022, to 13 in 2023.
• The South accounted for 53% of HIV diagnoses but only accounted for 39% of PrEP users. The South has the greatest unmet need for PrEP of all regions.

PrEP Use by Race/Ethnicity:

• Black people represent 39% of all new HIV diagnoses, but only accounted for 14% of PrEP users.
• Hispanic/Latinx people represent 31% of all new HIV diagnoses, but only accounted for 18% of PrEP users.
• White people represent 24% of all new HIV diagnoses but accounted for 64% of PrEP users.
• There is a greater unmet need for PrEP in Black and Hispanic/Latinx communities than White communities in all regions of the U.S.
• Regionally, Black people made up 48% of new HIV diagnoses in the South in 2022, but only 22% of PrEP users in the South in 2023; in the Midwest, Black people made up 42% of new HIV diagnoses in 2022, but only 13% of PrEP users in 2023.
• In the South, there were 25 white PrEP users for every new HIV diagnosis among white people. In comparison, there were only 5 Black PrEP users for every new HIV diagnosis among Black people.
• In the West, Hispanic/Latinx people represented 50% of new HIV diagnoses but only represented 24% of all PrEP users.

PrEP Use by Age:

• 64% of all PrEP users in 2023 were between ages 25 and 44 years old.
• Teenagers and young adults (aged 13-24 years) had the greatest unmet need for PrEP among all age groups, with a PrEP-to-Need Ratio (PnR) of 9. That means that for every person in that age group diagnosed with HIV, there were only 9 people using PrEP. People aged 35 to 44 had the highest PnR of 16.

PrEP Use by Sex:

• Among all PrEP users in the U.S., 92% were male and only 8% were female, despite the fact that women comprised 19% of new HIV diagnoses.

PrEP Use and Medicaid Expansion:

• In 2023, states that had expanded Medicaid had an average PrEP use rate that was 1.3 times higher compared with states that had not expand Medicaid.
• In 2023, states that had expanded Medicaid had an average PrEP-to-Need Ratio (PnR) that was 2 times as high compared to states that had not expanded Medicaid.

• • Note: 41 of the 51 US states + DC had adopted and implemented Medicaid expansion as of December 2023.

*Note: The PrEP-to-Need Ratio (PnR)—the ratio of the number of PrEP users to the number of people newly diagnosed with HIV—serves as a measurement for whether PrEP use appropriately reflects the need for HIV prevention in a geographic region or demographic subgroup. A lower PnR indicates more unmet need for PrEP.