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Disparities in PrEP Uptake
Actively Overcoming HIV Disparities: Your Role in PrEP Uptake 

Released: May 21, 2026

C. Randy Bornmann
C. Randy Bornmann, MD
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Key Takeaways
  • In the United States, the populations most affected by HIV—Black people, Hispanic/Latino people, and people younger than 24 years of age—are also among the least likely to be prescribed PrEP.
  • No matter your specialty, you have a role in taking active steps to discuss PrEP and HIV with these populations.  

Racial and ethnic disparities characterize HIV incidence in the USA, and the same holds true with access to HIV prevention. The same groups who are most affected by HIV—Black people, Hispanic/Latino people, and people younger than 24 years of age—are also among the least likely to be prescribed pre-exposure prophylaxis (PrEP).

The latest data (from 2022, before the CDC paused PrEP coverage reporting) shows that more than 94% of White people with indications for PrEP were prescribed it, compared to fewer than 15% of Black people and approximately 25% of Hispanic/Latino people. CDC data also showed disparities by sex and age: Women and younger people have much lower PrEP uptake than men and people older than 25 years of age. Limited data also suggest that PrEP use is lower in transgender women than in men who have sex with men.

In short, PrEP users—people who are benefitting from a key HIV prevention tool—are disproportionately White, male, and adult. And it’s up to us to ensure that everyone else doesn’t get left behind.

Lessons from Maryland
I practice in Baltimore, MD, a city with higher HIV prevalence and new diagnoses than the United States’ average. Here, racial and ethnic disparities in HIV incidence are large, and illustrative of trends observed nationwide: 65% of new diagnoses in 2023 were among non‑Hispanic Black people, 19% among Hispanic people, 12% among non‑Hispanic White people, and 5% among non-Hispanic people of another race. Expansion of PrEP is crucial for addressing the disparities in these communities, especially when these are the people where PrEP uptake is weakest.

I believe all healthcare professionals (HCPs) need to do better at focusing on education and access to PrEP among groups with a higher risk of HIV acquisition and low PrEP uptake. Education about what PrEP is and where to get it should be targeted towards both the general population and HCPs.

No matter your role in healthcare, you can normalize conversations about sexual health, substance use, and HIV risk. These conversations need not be limited to specialist clinics. I think it would be most impactful to expand these conversations to primary care/GYN office visits, sexual health clinics (especially for patients being seen for sexually transmitted infections), emergency departments, and substance use treatment programs. 

It is important to take a sexual and injection drug use history for all patients in an open, nonjudgmental manner, because stigma is known to be an important barrier to HIV care and prevention, especially in Black and Latino communities. I tell all my sexually active patients and those who use drugs that HIV acquisition can be prevented. Then, I ask them straightforward questions: Do you have sex without a condom with partners whose HIV status is unknown to you? Have you been diagnosed with an STI in the past six months? Do you inject drugs and share supplies?

It is important to ask without judgment, because people need to feel safe disclosing behaviors that are often deemed taboo in society. However, people do not need to disclose any risk to start PrEP. If someone says they want PrEP, they should be linked to care as soon as possible, regardless of any identified risks.

Discussions alone will not improve PrEP uptake. There are also structural barriers, such as health insurance and cost, not just for medication, but also for lab testing and office visits. Ideally, I feel HCPs need a way to offer PrEP and related services with zero out-of-pocket costs to increase uptake. Telehealth and same-day PrEP services can reduce access barriers, although these systems aren’t perfect, either. Online PrEP access is available in some areas, but these services often rely on mail services to deliver PrEP which delay initiation. Community members such as peer navigators can also be very beneficial at teaching about HIV prevention, including PrEP, and they are often more effective than HCPs at building trust and supporting people through the PrEP continuum. 

We have multiple effective options now for HIV prevention, including daily oral PrEP and PrEP injections that are dosed only a few times a year. The fact that we can prevent HIV with such high efficacy is extraordinary. I am hopeful that you and your local communities will work to expand knowledge about PrEP, rapidly link those at risk to care, and facilitate no-cost access to PrEP medications.

Your Thoughts
How do the lessons learned from increasing PrEP uptake in Baltimore, Maryland, translate to your own clinical practice? Leave a comment to join the discussion!

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