Fewer Black and Hispanic people than white people who are at risk of contracting HIV take preventive medication to keep them from catching the virus, both in Michigan and across the U.S., according to an Emory University study presented at the 24th International AIDS Conference in Montreal.
The study looked at the percentage by race of new cases and compared that with the percentage taking PrEP, a medicine that can prevent people from contracting the HIV virus that causes AIDS.
The study was released on AIDSVu, an online data site presented by Emory University’s Rollins School of Public Health in partnership with Gilead Sciences Inc., and the Center for AIDS Research at Emory University. PrEP (short for Pre-Exposure Prophylaxis) is manufactured by Gilead. The center is also funded by the National Institutes of Health.
"The main point of the work we're releasing today is to look at the match, does the profile of the users of PrEP match up with the profile of all the people who are at risk of HIV," said Dr. Patrick Sullivan, a professor of epidemiology at Emory and the principal scientist for AIDSVu, on Friday.
PrEP has been shown to reduce the chances of contracting AIDS through sexual contact or the sharing of needles for IV drug use, Sullivan explained.
The researchers looked at the most recent available data, and found that in Michigan there are 22.73 white individuals taking preventive medicine for every one new HIV diagnosis, versus only 2.59 Black people taking PrEP for every Black person diagnosed with the virus — even though Black people make up 57% of all new HIV diagnoses in Michigan.
Michigan Latinos accounted for 8% of new HIV diagnoses in the state in 2019, but only 5% of PrEP users in 2021. The study was based on the most recent data available.
Black and Hispanic people made up a greater percentage of newly diagnosed HIV cases in Michigan than nationally, according to the report.
On average across the country, Black people represented 42% of HIV diagnoses in 2020, and 14% of PrEP users in 2021. Hispanic people represented 27% of new HIV diagnoses nationally in 2020, and 17% of PrEP users in 2021.
Sullivan blamed the gap on economic and other disparities that contribute to health care inequities along racial lines across the country.
He noted the drug's cost can make it out-of-reach for people without health insurance, and noted the gap is greatest in the South, and in states that have not expanded Medicaid under the Affordable Care Act.
Michigan's Healthy Michigan Plan reached more than 1 million enrollees in May, Gov. Gretchen Whitmer's office announced.
People with insurance to cover the cost of the drug can still find the treatment inaccessible due to lack of transportation to clinics, their employment situation or other issues related to economic status, Sullivan said.
"People who live outside urban areas may have longer commutes to get to a PrEP provider, and in separate analyses we've shown that the time or distance it takes to get to PrEP may be associated with the likelihood that you're on PrEP," he noted.
Social stigma is also a factor in some people not choosing to take the drug, Sullivan noted, because in addition to being a preventive medication, PrEP is also used to treat people diagnosed with AIDS. So individuals living in crowded settings may be reluctant to be seen with the pills. The study looked only at people who have not been diagnosed with HIV, he explained.
Sullivan said the continuation of telehealth, used widely during the pandemic, and increased support in general for people accessing health care, would go a long way toward narrowing the gap.
"All these things together — the cost of health care, the travel — all of these things cumulatively present a set of barriers," Sullivan said. "And they largely track along lines of socioeconomic status."
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