BY Ethan Covey
Preexposure prophylaxis (PrEP) has increased among heterosexual adults in the United States. However, overall awareness and use of PrEP remains low among this group, highlighting the need for targeted educational campaigns and other outreach efforts (MMWR Morb Mortal Wkly Rep 2021;70[47]:1635-1639).
“PrEP is a highly effective way to prevent sexually transmitted HIV infection, and awareness of this potent prevention tool is needed to reach the goal of ending the HIV epidemic in the U.S.,” said Amy R. Baugher, MPH, an epidemiologist in the CDC’s Division of HIV Prevention. “The increased use of PrEP among heterosexual adults at risk for HIV infection could greatly reduce the current persistent racial, ethnic and gender disparities in HIV infection among these groups.”
Previous reports have shown that heterosexual sex is the identified route of transmission for 23% of new HIV diagnoses.
The analysis included data from the National HIV Behavioral Surveillance (NHBS) focused on heterosexually active adults in 23 cities with high HIV prevalence.
Overall, the study found that PrEP awareness among sexually active heterosexual adults at increased risk for HIV infection increased from 7% in 2016 to 32% in 2019.
“While this is a substantial increase, awareness is still concerningly low for groups that may be at increased risk of HIV infection,” Ms. Baugher said. “In comparison, a study of gay and bisexual men in select areas in 2017 found that more than 90% of gay and bisexual men were aware of PrEP.”
And significant racial, ethnic and gender disparities exist.
Awareness was especially low among Hispanic adults, with only about 20% of Hispanic men and 18% Hispanic women being aware of PrEP. Awareness also was particularly low (5.8%) among people residing in Puerto Rico.
PrEP use among eligible heterosexually active adults was very low (<1%), with only approximately one in three heterosexually active adults indicating awareness of PrEP. According to CDC’s most recent preliminary data on PrEP coverage, about 301,000 or 25% of people for whom PrEP is recommended were prescribed it.
“This is substantial progress from 2015 when roughly 3% of those recommended were prescribed PrEP, but far short of the estimated 50% of coverage that will be needed to reach the 2030 goal,” Ms. Baugher said.
While the NHBS data do not identify why gaps in awareness exist, Ms. Baugher noted that there are likely multiple reasons.
“Studies have indicated that heterosexual adults might not perceive themselves as being at risk for HIV infection or as candidates for PrEP,” she said. “We also know that persons at high risk for HIV infection need messaging customized for their population. Given the findings of this study, there is a clear need for culturally competent PrEP materials and campaigns designed to reach heterosexual adults, including heterosexual Hispanic adults.
“These findings also highlight the need for increased provider–patient communication about PrEP during routine health screenings and primary care visits,” Ms. Baugher continued. “Primary care physicians and obstetricians and gynecologists can use routine visits and testing encounters for HIV and sexually transmitted infections to discuss PrEP with heterosexual patients and determine if PrEP is recommended. Providers can use CDC’s HIV Nexus as a one-stop resource for up-to-date provider tools and guidelines for HIV and PrEP.”
