Abstract
Abstract
Background
Structural racism contributes to geographical inequalities in pre-exposure prophylaxis (PrEP) coverage in the United States (US). This study aims to investigate county-level variability in PrEP utilization across diverse dimensions of structural racism.
Methods
The 2013–2021 nationwide county-level PrEP rate and PrEP-to-need ratio (PNR) data were retrieved from AIDSVu. PrEP rate was defined as the number of PrEP users per 100,000 population, and PNR was defined as the ratio of PrEP users to new HIV diagnoses per calendar year. Linear mixed effect regression was employed to identify associations of county-level structural racism (e.g., structural racism in housing and socioeconomic status) with PrEP rate and PNR on a nationwide scale of the US.
Results
From 2013 to 2021, the mean PrEP rate and PNR increased from 3.62 to 71.10 and from 0.39 to 10.20, respectively. Counties with more structural racism in housing were more likely to have low PrEP rates (adjusted β = − 5.80, 95% CI [− 8.84, − 2.75]). Higher PNR was found in counties with lower structural racism in socioeconomic status (adjusted β = − 2.64, 95% CI [− 3.68, − 1.61]). Regionally, compared to the Midwest region, counties in the West region were more likely to have higher PrEP rate (adjusted β = 30.99, 95% CI [22.19, 39.80]), and counties in the South had lower PNR (adjusted β = − 1.87, 95% CI [− 2.57, − 1.17]).
Conclusions
County-level structural racism plays a crucial role in understanding the challenges of scaling up PrEP coverage. The findings underscore the importance of tailored strategies across different regions and provide valuable insights for future interventions to optimize PrEP implementation.
Funder
National Institute of Nursing Research
University of South Carolina
Publisher
Springer Science and Business Media LLC
Reference35 articles.
1. Fauci AS, et al. Ending the HIV epidemic: a plan for the United States. JAMA. 2019;321(9):844–5.
2. Doherty R, et al. Association of race and other social determinants of health with HIV pre-exposure prophylaxis use: a county-level analysis using the prep-to-need ratio. AIDS Educ Prev. 2022;34(3):183–94.
3. The center for disease control and prevention, PrEP for HIV prevention in the U.S. 2021. [cited 2024 Jan 16], Available from: https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/PrEP-for-hiv-prevention-in-the-US-factsheet.html
4. AIDSVu. AIDSVu releases new data highlighting ongoing inequities in PrEP use among Black and Hispanic people and across regions of the country. 2023. [cited 2024 Jan 16]. Available from: https://aidsvu.org/news-updates/news-updates-aidsvu-releases-new-data-highlighting-ongoing-inequities-in-prep-use-among-black-and-hispanic-people-and-across-regions-of-the-county/.
5. The center for disease control and prevention, Core indicators for monitoring the ending the HIV epidemic initiative (early release): National HIV Surveillance System data reported through December 2020; and preexposure prophylaxis (PrEP) data reported through September 2020. 2021.