Building Racial and Gender Equity into a National PrEP Access Program

Jeremiah Johnson, Asa Radix, Raniyah Copeland, Guillermo Chacón, Jeremiah Johnson, Asa Radix, Raniyah Copeland, Guillermo Chacón

Abstract

Transgender and gender diverse (TGD), Black, and Latinx communities have long borne a disproportionate share of the U.S. HIV epidemic, yet these same key demographics are continually underrepresented in national PrEP prescriptions. Black, Latinx, and TGD individuals are also more likely to be uninsured, meaning that a proposed federal program to cover PrEP for people without insurance could provide significant benefit to potential PrEP users from these populations. However, coverage of PrEP costs alone will not end disparities in uptake. This commentary provides additional context and recommendations to maximize effectiveness of a national PrEP program for TGD, Black, and Latinx populations in the US.

Keywords: Gender Equity; HIV; Pre-exposure Prophylaxis (PrEP); Racial Equity; Uninsured.

References

    1. Bosh K.A., Hall H.I., Eastham L., Daskalakis D.C., and Mermin J.H., “Estimated Annual Number of HIV Infections: United States, 1981–2019,” Morbidity and Mortality Weekly Report 70, no. 22 (2021): 801.
    1. Id.
    1. Cohen R.A., Terlizzi E.P., Cha A.E., and Martinez M.E., Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2020 (2021), available at <> (last visited April 1, 2022).
    1. Centers for Disease Control and Prevention, “HIV Infection, Risk, Prevention, and Testing Behaviors among Transgender Women–National HIV Behavioral Surveillance, 7 US cities, 2019–2020,” Surveillance Special Report 27 (2021), available at <> (last visited April 1, 2022).
    1. Killelea A., “Financing and Delivering Pre-Exposure Prophylaxis (PrEP) to End the HIV Epidemic,” Journal of Law, Medicine & Ethics 50, no. 2, Suppl. (2022): 8–23.
    1. Pathela P., Jamison K., Blank S., Daskalakis D., Hedberg T., and Borges C., “The HIV Pre-exposure Prophylaxis (PrEP) Cascade at NYC Sexual Health Clinics: Navigation Is the Key to Uptake,” JAIDS Journal of Acquired Immune Deficiency Syndromes 83, no. 4 (2020): 357–364.
    1. White Hughto J.M., Reisner S.L., and Pachankis J.E., “Transgender Stigma and Health: A Critical Review of Stigma Determinants, Mechanisms, and Interventions,” Society of Science & Medicine 147 (2015): 222–231.
    1. Branson B.M., Handsfield H.H., Lampe M.A., Janssen R.S., Taylor A.W., Lyss S.B., and Clark J.E., “Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings,” MMWR Recommendations and Reports 55 (2006): (Rr-14), 1–17; quiz CE11-14.
    1. Pitasi M.A., Oraka E., Clark H., Town M., and DiNenno E.A., “HIV Testing among Transgender Women and Men - 27 States and Guam, 2014-2015,” MMWR Morbidity and Mortality Weekly Report 66, no. 33 (2017): 883–887.
    1. Grant J.M., Mottet L.A., and Tanis J., National Transgender Discrimination Survey Report on Health and Health Care (2010).
    1. Fisher C.B., Fried A.L., Desmond M., Macapagal K., and Mustanski B., “Perceived Barriers to HIV Prevention Services for Transgender Youth,” LGBT Health 5, no. 6 (2018): 350–358; C.T. Rael, M. Martinez, R. Giguere, W. Bockting, C. MacCrate, W. Mellman, P. Valente, G.J. Greene, S. Sherman, K.H.A. Footer, R.T. D’Aquila, and A. Carballo-Dieguez, (2018). “Barriers and Facilitators to Oral PrEP Use Among Transgender Women in New York City,” AIDS Behavior 22, no. 11 (2018): 3627-3636; J.M. Sevelius, J. Keatley, N. Calma, and E. Arnold, (2016). “‘I Am Not a Man’: Trans-Specific Barriers and Facilitators to PrEP Acceptability among Transgender Women,” Global Public Health 11, nos. 7-8 (2015): 1060-1075; E.C. Wilson, H. Jin, A. Liu, and H.R. Raymond, “Knowledge, Indications and Willingness to Take Pre-Exposure Prophylaxis among Transwomen in San Francisco, 2013,” PloS One 10, no. 6 (2015): e0128971.
    1. Spinelli M.A., Scott H.M., Vittinghoff E., Liu A.Y., Gonzalez R., Morehead-Gee A., Gandhi M., and Buchbinder S.P., “Missed Visits Associated with Future Preexposure Prophylaxis (PrEP) Discontinuation among PrEP Users in a Municipal Primary Care Health Network,” Open Forum Infectious Disease 6, no. 4 (2019): ofz101.
    1. Ojikutu B.O. and Mayer K., “HIV Prevention among Black Women in the US — Time for Multimodal Integrated Strategies,” JAMA Network Open 4, no. 4 (2021): e215356–e215356.
    1. Ojikutu B.O., Bogart L.M., Higgins-Biddle M., Dale S.K., Allen W., Dominique T., and Mayer K.H., “Facilitators and Barriers to Pre-exposure Prophylaxis (PrEP) Use among Black Individuals in the United States: Results from the National Survey on HIV in the Black Community (NSHBC),” AIDS and Behavior 22, no. 11 (2018): 3576–3587.
    1. Ojikutu B.O. and Mayer K.H., “Hidden in Plain Sight: Identifying Women Living in the United States Who Could Benefit from HIV Preexposure Prophylaxis,” Journal of Infectious Diseases 222, no. 9 (2020): 1428–1431.
    1. Alsan M., Garrick O., and Graziani G., “Does Diversity Matter for Health? Experimental Evidence from Oakland,” American Economic Review 109, no. 12 (2019): 4071-4111.
    1. Wheeler D.P., Fields S.D., Beauchamp G., Chen Y.Q., Emel L.M., Hightow‐Weidman L., Hucks‐Ortiz C. et al.., “Pre‐exposure Prophylaxis Initiation and Adherence among Black Men Who Have Sex with Men (MSM) in Three US Cities: Results from the HPTN 073 Study,” Journal of the International AIDS Society 22, no. 2 (2019): e25223.
    1. Mansergh G., Koblin B.A., and Sullivan P.S., “Challenges for HIV Pre-exposure Prophylaxis among Men Who Have Sex with Men in the United States,” PloS Medicine 9, no. 8 (2012): e1001286.
    1. Ayala G., Makofane K., Santos G.-M., Beck J., Do T.D., Hebert P., Wilson P.A., Pyun T., and Arreola S., “Access to Basic HIV-Related Services and PrEP Acceptability among Men Who Have Sex with Men Worldwide: Barriers, Facilitators, and Implications for Combination Prevention,” Journal of Sexually Transmitted Diseases 2013 (2013).
    1. Kuehn B.M., “Low PrEP Awareness, Referrals for Black, Hispanic, and Latino People,” JAMA 326, no. 18 (2021): 1786–1786.

Source: PubMed

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