Racial/Ethnic Disparities in HIV Preexposure Prophylaxis Among Men Who Have Sex with Men — 23 Urban Areas, 2017, Kanny D, Jeffries WL IV, Chapin-Bardales J, et al., National HIV Behavioral Surveillance Study Group, CDC (2019)

This preliminary analysis of data from the 2017 National Behavioral Health Survey (NBHS) confirms anecdotal reports that black and Hispanic men who have sex with men (MSM) are connected to access to HIV pre-exposure prophylaxis (PrEP) medication at starkly lower rates than their white peers.

The study, published in a CDC Morbidity and Mortality Weekly Report (MMWR) in 2019, locates the problem in a number of places in the care continuum, but specifically notes that the problem begins at the point of discussion between health providers and patients. The issue is illustrated by the data demonstrating that white vs. black disparities in PrEP usage persist even among those with health insurance, suggesting that providers offer PrEP to black patients at lower rates than white patients and fewer black patients accept those prescriptions. The study speculates that some reasons for that prescription gap are the persistence of inaccurate assumptions by providers about black MSM patients, medical mistrust among black patients, and a lack of culturally informed training on how to discuss sensitive topics such as sexual history with diverse patient populations.

This new analysis confirms that any successful plan to End the Epidemic must address the disparate treatment of non-white individuals by their medical providers. This report, by documenting that there is a racial uptake gap even among patients with access to health care, confirms that it is equally important that we address medical racism if we are going to substantially improve health and reduce new transmissions among people of color affected by HIV.