How can PrEP use among Black people be improved?

Black patients account for 42 percent of new HIV diagnoses in the U.S., despite making up just 13 percent of the country’s population. So why is PrEP use so low?

AIDSVu released findings in 2023 that showed Blacks represented only 14 percent of PrEP users. That varies somewhat by region.

“Regionally, Black people made up 48 percent of new HIV diagnoses in the South, but only 21 percent of PrEP users in the South; in the Midwest, Black people made up 48 percent of new HIV diagnoses, but only 12 percent of PrEP users,” the study found.

Antoine Pollard is the community engagement coordinator with Us Helping Us, a nonprofit in the Washington, D.C., area that provides HIV testing and treatment services to Black communities. This includes encouraging PrEP use. “We partner with a lot of community groups and organizations,” he says, including speaking at and sponsoring various events to increase awareness.

Teaching people about the ease of use of modern PrEP is important, says Pollard; if people are uncomfortable with injectable medications, oral pills are also available.

A variety of social stigmas and income issues contribute to the low use, but lack of access also impacts the situation. A National Institutes of Health study released in 2024 found that only 10.3 percent of Black Americans had PrEP coverage, the lowest of any racial demographic, despite being at the highest risk of HIV infection. By comparison, white people had an average PrEP coverage rate of 74 percent.

That was before a 2025 Supreme Court ruling made clear that legislative bodies could require insurance carriers to cover the use of PrEP, and trends were already on the rise. But it will still take proactive steps to improve PrEP use in Black communities.

Of note, another NIH study revealed a number of disparities among at-risk patients in the Atlanta area, historically a part of the country known to have the highest rates of new HIV diagnoses. It found much greater challenges for Black men, especially LGBTQ+ men of color, in obtaining access to basic health care.

Studies have also shown a higher interest in PrEP use among Black men than women, despite 18 percent of new HIV diagnoses in the country impacting Black female patients.

Black women also have lower rates of PrEP use despite having higher rates of HIV diagnoses.insta_photos/Shutterstock

“Although there is high access to and uptake of PrEP, many groups, particularly Black women, still face barriers to access and initiate PrEP,” researchers Hema Jalaparthi and Mandy Hill noted in a paper published last year by Frontiers in Sociology. “Fewer than 2 percent of cisgender Black women indicated for PrEP in the U.S. have received a prescription.”

The paper argued that the high infection rates in Black American communities constituted a medical emergency, and health care professionals need to actively encourage the use of PrEP to more patients. It cited that many women would consider the use of PrEP if a doctor recommended it. However, medical mistrust within the Black community is another obstacle.

“Notably, medical mistrust was negatively associated with comfort in discussing PrEP with healthcare providers,” the Jalaparthi-Hill paper reads. “These findings underscore the need for culturally sensitive approaches that build trust and strengthen provider-patient communication to address misconceptions, enhance awareness, reduce stigma, and support informed decision-making about sensitive topics such as HIV risk and PrEP prevention.”