Low HIV PrEP Awareness and Referrals among High-Risk Hispanic Populations

Hispanic or Latino persons are disproportionately affected by HIV. As of 2019, Hispanic persons were 18% of the US population, but represented 29% of new HIV diagnoses. Pre-exposure prophylaxis (PrEP) is an effective strategy for preventing HIV infection among high-risk groups. To gauge if Hispanic persons were aware of and being referred for PrEP, the CDC conducted an analysis of the 2019 National HIV Prevention Program Monitoring and Evaluation HIV testing data.

This data was submitted by 60 CDC-funded state, local, and territorial health departments and 29 directly funded community-based organizations. People who are HIV-negative are eligible for a PrEP referral and subsequent prescription if they meet the clinical criteria designated by local protocol or CDC guidelines.

HIV test providers were surveyed with the questions, “Has the client ever heard of PrEP?”, and “Was the client given a referral to a PrEP provider?” HIV PrEP awareness and referral were then compared across racial and ethnic groups, while also monitoring age, gender, test setting, US Census region, and transmission risk. The CDC investigators used Poisson regression to calculate the prevalence ratios (PRs) and 95% confidence intervals (CIs).

In 2019, the CDC funded 2341342 HIV tests, including 546337 (23.3%) conducted among Hispanic persons, 919066 (39.3%) among non-Hispanic Black/African American (Black) persons, 658496 (28.1%) among non-Hispanic White (White) persons, and 217443 (9.3%) among persons of other or unspecified race.

One in four (27%; n=310954) Hispanic persons tested for HIV at CDC-funded clinics was aware of PrEP. Of those who tested HIV-negative and were eligible to be referred for PrEP, one in five (22%; n=111644) were referred to providers. PrEP awareness and referrals were slightly higher among Hispanic persons than non-Hispanic Black persons (26.2%), but lower than among white persons (31.4%) and other racial or ethnic populations (42.1%).

Among the Hispanic study population, there were significant differences in PrEP awareness and referrals by age, gender, race, geographic region, and test setting. Awareness was higher among persons 25-49 years of age (29.9%) than those 13-24 years of age (28.1%) and over 50 years of age (17%). By gender, females were the least likely to be aware of PrEP (14.5%), followed by males (36.6%), with transgender persons the most likely to be aware of PrEP (68.6%). Hispanic persons tested in the South (13.4%) and US territories (12.9%) were the least likely to be aware of PrEP, despite these areas being disproportionately affected by HIV.

The CDC recommended HIV testing programs expand PrEP services for Hispanic persons by implementing linguistic and cultural strategies to address individual, social, and structural barriers.