According to DAP Health PrEP Navigation Manager Andy Glorioso, any racial imbalance is not due to less access. Rather, we need more education.

Words by Daniel Hirsch

Since its arrival in 2012, pre-exposure prophylaxis (PrEP) has revolutionized the fight to stop the spread of HIV. Its usage in the U.S. has climbed steadily over the last decade — from around 9,000 users to over 300,000, according to Center for Disease Control (CDC) data.

However, a grim reality sadly persists. Huge disparities exist in terms of who is accessing PrEP, and which communities are benefiting from the lowered HIV infection rates the 99% effective drug can bring. “Disparities in PrEP follow the same disparities in sexual health in the general population,” says DAP Health PrEP Navigation Manager Andrew Glorioso.

PrEP usage rates reveal deep-seated inequities along racial lines. In a 2024 study in the journal Health Equity, research from 2019 to 2022 that analyzed a pool of people deemed at high risk for contracting HIV found that among White people, 74% were accessing PrEP. In this same group, the coverage rate for Latinos was only 18.9%, and for Black people, just 10.3%.

Incidence rates of HIV infections are much higher in these non-White populations. According to CDC data, Black people make up 42% of HIV diagnoses, while Latinos make up 35%, even though they only represent 13% and 19% of the general population, respectively.

Disparities like these make Glorioso’s job vital. The PrEP Navigation team he manages helps people who don’t otherwise have — but would benefit from — access to PrEP. “We can get PrEP for 100% of individuals who come to our door,” says Glorioso, adding that his team can get patients a month of generic oral PrEP (brand name, Truvada) for as little as no cost, or for no more than $9, depending on insurance status.

“So, it’s not a disparity of access to PrEP, but a disparity in education,” maintains Glorioso. “But in order to be able to educate people about PrEP, we have to be able to talk openly about sex. Stigma related to the perception that going to the sexual wellness clinic means you’ve been a bad person trickles down to PrEP.”

The Health Equity journal study similarly cites cultural attitudes as a big factor in who is accessing PrEP. Historically marginalized communities may mistrust medical institutions — which themselves might have a problematic legacy of institutional racism — and choose to not adopt novel medical interventions like PrEP.

Pervasive homophobia, transphobia, and biphobia may also inhibit patients from talking to their doctors about HIV prevention. Compounding this is the fact that many doctors are either not trained in PrEP, or have cultural biases or beliefs that limit their willingness to prescribe it.

Years ago, a young Latino man named Gary, from the Eastern Coachella Valley, asked his family physician for a PrEP prescription. “He told me he would be happy to prescribe it,” Gary remembers. “But only after I underwent a psychiatric evaluation to find out why I would want to not use condoms!” A friend wisely counseled Gary to find a better educated, more gay-friendly doc, from whom he has gotten his PrEP for free ever since.

Geography further contributes to all these factors. If one lives in a state where HIV prevention programs have been cut, or in a community without primary care clinicians informed about PrEP, it’s obviously harder to access prevention. New online medical delivery services like Mistr may change that, but Glorioso says even that has limits in reach. “It is a very viable option for a lot of people, but to whom is Mistr doing their advertising and marketing? It’s often a specific set of individuals,” he says.

Glorioso is referring to those who have historically had the highest HIV risk: cisgender men who have sex with one another. However, targeting this population leaves many out. A 2024 study published in The Lancet found that PrEP uptake rates in women are far below what’s epidemiologically necessary.

Data has long been limited on PrEP usage among trans people, but one 2020 study from UCLA estimated as little as 3% of trans people at high risk for HIV are taking it. As PrEP usage in general has risen over the last four years, that number is likely to have improved, but recent data from the CDC shows HIV infection rates are disproportionally rising among trans women by a rate of 25% over this four-year stretch — impacting Black and Latino trans women at the highest level.

How does an organization like DAP Health address barriers to care? For Glorioso, it’s by continuing to educate, offer culturally competent services, and show up where there’s unmet need. He says the 2022 establishment of a free DAP Health sexual wellness clinic in Indio, catering to the Eastern Coachella Valley’s predominantly Latino community, was a big step in the right direction. “We need to keep raising visibility,” he stresses. “Now that the DAP Health footprint is larger [following the nonprofit’s recent expansion to the San Diego coast], the plan is to look for more sites that may need additional PrEP navigation services.”

If everyone who would benefit from PrEP knew how to access it — and if every HIV positive individual knew their status and had access to antiretroviral treatment — the potential impact is almost unthinkable: the end of HIV’s spread. But striking down the virus for good has never been just about medicine. It’s about ending inequality too.

If you would like access to PrEP or PEP, or if you need free HIV testing — whether that be in person at one of our sexual wellness clinics, or by having a test discreetly mailed to your home — please click here.

If you need HIV/AIDS care and are not yet a DAP Health patient, please click here.