HIV PrEP Use Among Heterosexual Adults Is Negligible, CDC Reports

Heterosexual sex accounts for 23% of new HIV diagnoses each year. However, heterosexual people are drastically underrepresented in HIV preexposure prophylaxis (PrEP) research and campaigns. As a result, many heterosexual Americans are neither aware of their relative risk nor taking proper precautions.

In their Morbidity and Mortality Weekly Report, the US Centers for Disease Control and Prevention (CDC) reported that only 32.3% of heterosexual adults are aware of PrEP, and less than 1% use it.

The study included 9359 participants, all of whom consented to face-to-face interviews. The study was conducted among heterosexually active adults in 23 urban areas with high HIV prevalence. Analysis was limited to participants who tested negative for HIV and reported low income; the National HIV Behavioral Surveillance (NHBS) uses low income as a risk indicator of HIV infection through heterosexual activity.

“PrEP awareness” was simply defined as having heard of PrEP. Though not all participants may have been eligible for PrEP, PrEP awareness and general HIV prevention knowledge is beneficial for all persons.

The investigators assessed demographic and social determinants of health using log-linked Poisson regression models. Because PrEP use was <1%, it could not be analyzed nor stratified.

PrEP awareness and uptake are stratified by race, ethnicity, and gender. Awareness was lowest among Hispanic/Latinx men (19.5%) and women (17.6%), and among Puerto Rico residents (5.8%). Overall, men had lower PrEP awareness than women (29.2% versus 34.8%).

Uninsured participants had lower PrEP awareness than the insured (26.4% versus 34.2%). There was a significant disparity between non-US-born participants who did not speak English well and US-born participants (6.5% versus 35.2%).

The CDC cited past studies that suggest heterosexual adults are interested in taking PrEP when they learn about it, indicating that tailored PrEP messaging, especially in Spanish, could help reach this key demographic.

There is a high prevalence of HIV infection among Black Americans, and they had a higher PrEP awareness than white or Hispanic persons, which the CDC attributed to HIV prevention campaigns targeted toward Black persons.

The results suggested that targeted PrEP campaigns and routine screenings can increase PrEP awareness and uptake, especially among Hispanic adults. HIV PrEP campaigns are usually directed to men who have sex with men, so many heterosexual adults may be unaware of PrEP and their own HIV risk.