Race and the public health impact potential of PrEP in the United States

Issues:  Early evidence is emerging around racial disparities in PrEP-knowledge, -healthcare seeking behavior, and -uptake. Few Black men who have sex with men (MSM) are engaged in PrEP implementation projects, which is striking, given that there is high and increasing HIV incidence among younger Black MSM in major urban areas across the U.S. These worrisome trends are emerging at a time when many Black communities are expected to have increased health care access as the Affordable Care Act is fully implemented.

Description: PrEP Chicago is an intervention that couples network level diffusion of innovation with linkage to PrEP care in community areas at high risk for ongoing HIV transmission. Early diffusion including knowledge, preparation and adoption are a major focus. Purposeful selection and training of peer change agents to drive diffusion through person to person communication and motivation leads to PrEP engagement and linkage to care. 

Lessons Learned: Diffusion of innovation in community areas such as the South Side is largely word of mouth and most effective from a grassroots or bottom-up approach.  While Medicaid expansion makes PrEP care more accessible, navigation of different medical homes, insurance providers and referral restrictions adds additional complications to PrEP care engagement. In contexts without Medicaid expansion, additional barriers likely exist.

Recommendations: Real-world PrEP access and utilization by those with highest HIV incidence, such as younger Black MSM, faces major implementation challenges that require purposeful and sustained engagement with racial/ethnic minority communities and navigation of a complicated health care environment.