Deeper Look: PrEP

The PrEP utilization data on AIDSVu reveal that the number of PrEP users in the U.S. increased by 23% from 2020 to 2021, continuing a trend of consistent growth in PrEP use since 2012. In addition, AIDSVu’s PrEP use data by race/ethnicity reveal that Black people represented 14% of PrEP users in 2021, but 42% of new HIV diagnoses in 2020, while Hispanic/Latinx people represented 17% of PrEP users in 2021 and 27% of new HIV diagnoses in 2020.

PrEP, or pre-exposure prophylaxis, is when people at risk for HIV take or receive HIV medicine regularly to lower their chances of getting infected with HIV.  The Centers for Disease Control and Prevention (CDC) has estimated that approximately 1.2 million people are at high risk for HIV exposure and could benefit from comprehensive HIV prevention strategies, including 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 56% average annual increase in persons using PrEP across the U.S. — including a 23% increase from 2020 to 2021. 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, 30,346 people were diagnosed with HIV in 2020, 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 2021, can be stratified by age and sex. State-level maps from 2021-2021 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.

(PrEP use data is from 2021, and new diagnoses data is from 2020, unless otherwise noted. Due to the COVID-19 pandemic, all data from 2020 should be interpreted with caution)

Overall PrEP Use

• The number of PrEP users in the U.S. increased by 23% from 2020 to 2021, continuing a trend of consistent growth in PrEP use since 2012.
• Although PrEP use has increased steadily every year since 2012, there was a much lower rate of increase in 2020 of only 11% from 2019. This lower pace of growth occurred during the COVID-19 pandemic.
• The South accounted for 52% of HIV diagnoses but only accounted for 39% of PrEP users.
• In 2021, states that had expanded their Medicaid programs had rates of PrEP use that were 1.5X higher than states that did not expand Medicaid.
• Among all PrEP users in the U.S., 92% were male and only 8% were female, despite the fact that women comprised 18% of new HIV diagnoses.
• Teenagers and young adults (aged 13-24 years) had the greatest unmet need for PrEP among all age groups, with a PNR of 6*accounting for 20% of new HIV diagnoses but only 13% of PrEP users.

* PrEP-to-Need Ratio (PNR) is the ratio of the number of PrEP users in 2021 to the number of people newly diagnosed with HIV in 2019. It is a measurement for whether PrEP use appropriately reflects the need for HIV prevention. A lower PNR indicates more unmet need.

PrEP Use by Race/Ethnicity

• Black people represented 14% of PrEP users, but 42% of new HIV diagnoses.
• Hispanic/Latinx people represented 17% of PrEP users and 27% of new HIV diagnoses
• White people represented 65% of PrEP users and 26% of new HIV diagnoses.
• Regionally, Black people made up 52% of new HIV diagnoses in the South, but only 21% of PrEP users in the South; in the Midwest, Black people made up 48% of new HIV diagnoses, but only 12% of PrEP users.
• Of the 7 states with the greatest unmet need for PrEP among Black people, three were in the South (Arkansas, Mississippi, and Alabama) and three were in the Midwest (North Dakota, South Dakota, and Iowa). These states have a PrEP-to-Need Ratio (PNR) of less than 2 (i.e., fewer than 2 PrEP users for every new HIV diagnosis)*.
• In the West, Hispanic/Latinx people represented 43% of new HIV diagnoses but only represented 22% of all PrEP users.