ArticleJournal of racial and ethnic health disparities2025
Structural Racism and HIV Pre-exposure Prophylaxis Use in the Nationwide US: A County-Level Analysis.
Article in Journal of racial and ethnic health disparities, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- HIV Preventive Measures' Adoption Among Men Who Have Sex With Men in West and Central Africa: A Scoping Review On Pre-exposure Prophylaxis and Condom Use.Journal of community health · 2026Review
- County-Level New HIV Diagnoses, Social Determinants of Health, and Residential Segregation by U.S. Region 2013 to 2023: A Longitudinal Analysis.AIDS and behavior · 2026Article
- Mortgage discrimination at the intersection of race and sexual orientation and its association with HIV incidence among sexual minority men in the U.S.Annals of epidemiology · 2025Article
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Authors and funding
6 authors.
Funding
Abstract
backgroundStructural racism contributes to geographical inequalities in pre-exposure prophylaxis (PrEP) coverage in the United States (US). This study aims to investigate county-level variability in PrEP utilization across diverse dimensions of structural racism.
methodsThe 2013-2021 nationwide county-level PrEP rate and PrEP-to-need ratio (PNR) data were retrieved from AIDSVu. PrEP rate was defined as the number of PrEP users per 100,000 population, and PNR was defined as the ratio of PrEP users to new HIV diagnoses per calendar year. Linear mixed effect regression was employed to identify associations of county-level structural racism (e.g., structural racism in housing and socioeconomic status) with PrEP rate and PNR on a nationwide scale of the US.
resultsFrom 2013 to 2021, the mean PrEP rate and PNR increased from 3.62 to 71.10 and from 0.39 to 10.20, respectively. Counties with more structural racism in housing were more likely to have low PrEP rates (adjusted β = - 5.80, 95% CI [- 8.84, - 2.75]). Higher PNR was found in counties with lower structural racism in socioeconomic status (adjusted β = - 2.64, 95% CI [- 3.68, - 1.61]). Regionally, compared to the Midwest region, counties in the West region were more likely to have higher PrEP rate (adjusted β = 30.99, 95% CI [22.19, 39.80]), and counties in the South had lower PNR (adjusted β = - 1.87, 95% CI [- 2.57, - 1.17]).
conclusionsCounty-level structural racism plays a crucial role in understanding the challenges of scaling up PrEP coverage. The findings underscore the importance of tailored strategies across different regions and provide valuable insights for future interventions to optimize PrEP implementation.
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