In 2019, Black and Latino Americans who tested negative for HIV were the least likely to be referred to clinicians who could provide pre-exposure prophylaxis (PrEP), according to data published in Morbidity and Mortality Weekly Report. Despite accounting for 71% of all new HIV diagnoses that year, Black and Latino people accounted for only 42% of PrEP referrals.

Shubha Rao, MPH, of the Centers for Disease Control and Prevention (CDC), and colleagues reviewed 2019 National HIV Prevention Program Monitoring and Evaluation testing data. The data came from 60 state, local and territorial health departments that receive CDC funding as well as 29 community-based groups funded by the CDC. They looked at how often people get tested for HIV and then receive referrals for PrEP. The study was done before the CDC updated its PrEP guidelines to suggest that clinicians talk to every sexually active adolescent and adult about PrEP and to prescribe PrEP to anyone who asks for it.

Of the 2.3 million CDC-funded HIV tests conducted in the United States in 2019, nearly a quarter, 23%, were for Latinos—a lower rate than testing among Black or white Americans, who made up 39% and 28% of HIV testers, respectively. That’s lower than the rate of new HIV diagnoses among Latinos, who make up 18% of the U.S. population but account for 29% of new diagnoses.

About 27% of Latinos who got HIV tests had heard of PrEP. Latinos of transgender experience were the most aware of PrEP (69%), followed by Latino cisgender men (37%) and finally cisgender Latinas (15%). Black Latinos and Latinos of other non-white identities were more likely to have heard of PrEP, at 39% each, while white Latinos were the least likely, with only one in five being aware of it. Meanwhile, 64% of gay and bisexual Latino men had heard of PrEP, compared with 29% of Latinos who inject drugs and 22% of Latino straight men.

Interestingly, people were more likely to have heard of PrEP if they received an HIV test at a community venue rather than at a clinic (35% versus 18%). People in U.S. territories, including Puerto Rico, and in the South were least likely to be aware of PrEP, at 13% each.

PrEP referrals were roughly proportionate for white people who tested for HIV in 2019: This group accounted for one in four HIV diagnoses and one in four PrEP referrals for those who tested negative. In contrast, nearly half of new diagnoses (42%) were for Black folks in 2019, but only one in five (21%) received PrEP referrals. Meanwhile, Latinos accounted for one in three new HIV diagnoses but just one in five (22%) received PrEP referrals.

“Broader implementation of PrEP services among Hispanic persons at risk for HIV infection is an essential strategy of the EHE [‘Ending the HIV Epidemic’] initiative,” wrote Rao and colleagues. “HIV prevention programs can help achieve the goals of the EHE initiative by addressing individual, social and structural barriers to receipt of PrEP services, collaborating with health care and other providers, and expanding health care coverage, and implementing culturally and linguistically relevant strategies for Hispanic persons.”

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