Gaps and Determinants in PrEP Uptake and Need: Understanding Disparities in PrEP Among Women in the United States

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ABSTRACT Women accounted for 18% of new HIV diagnoses in the United States in 2020 and yet only 7.4% of the pre- exposure prophylaxis (PrEP) users. Additionally, 71% of the women diagnosed with HIV in 2020 were Black/African American or Hispanic. PrEP has been shown to reduce incident HIV infection, providing a substantial public health opportunity to work towards the US Department of Health and Human Services announced the Ending the HIV Epidemic initiative. However, a substantial component of risk of HIV infection for women relates to the behaviors of their male sex partners, and these risks of partners may be unknown to women. Additionally, the completeness of data on race/ethnicity in key datasets used to document PrEP users in the US is limited leading to bias in our estimates. The proposed analysis will (1) determine the characteristics of women based on their partnerships that are indications for PrEP, particularly those indications unrecognized by women and their healthcare providers, 2) use multiple imputation to complete race/ethnicity data in current pharmaceutical use datasets to better understand the current racial/ethnic distribution of women PrEP users, and 3) analyze spatio-temporal patterns of PrEP uptake among women in the United States. Taken together, the goal of this proposal is to advance our understanding of among whom PrEP is needed, racial/ethnicity distributions among whom PrEP is currently being utilized, and where uptake is disparate considering risk factors for HIV infection.