Even Insured Black Gay Men Still Aren’t Getting Equal Access to PrEP

September 24, 2019

There’s a pill that can prevent new HIV infections—but, among queer men, it still mostly remains in the prescription bottles of white folks, even though Black and Brown men who have sex with men (MSM) are seeing the highest rates of new HIV infection.

One strategy to closing the gap for “high-risk” populations has been to offer cost-free insured access to pre-exposure prophylaxis for HIV (PrEP), which was ushered in when the US Preventative Services Task Force gave the medication a “grade-A” rating in June of this year.

But even if it’s more affordable, racial disparities still persist across people with health insurance, according to a September 20 Centers for Disease Control and Prevention (CDC) report that looked at Black, Latino and white MSM patients’ use of PrEP and its discussion with physicians in 2017.

That year, new HIV infection diagnoses were starkly different: Black men who were infected by way of sex with men accounted for the largest number of them, 9,807, while white MSM saw 6,982.

HIV infections could be hitting Black men more because of the silence they experience in the doctor’s office. Only 43 percent of the Black MSM included in the recent CDC report had discussed PrEP with their physician in the past year. More than half (58 percent) of white MSM respondents talked with their doctors about the medication, which is still far too low.

For respondents who had health insurance and ended up talking to their doctors, Black MSM still saw the lowest rates of PrEP use (57 percent) while white MSM enjoyed the highest (70 percent). The CDC researchers noted that this could be due to the unsupportive relationships Black and Brown patients experience with their doctors, being “more likely to experience communication difficulties, such as having trouble understanding their doctor, feeling like their doctor did not listen to them or did not ask the questions they would have liked or expected, and feeling less involved in decisions regarding their own health care than do whites.”

Additionally, the researchers noted that PrEP use may be so low for MSM of color who have health insurance because doctors may be making “clinical decisions derived from inaccurate assumptions about racial/ethnic minority patients”—such as perceptions about their ability to adhere to medication regimens.

“PrEP is a highly effective and underused prevention tool for all MSM at high risk for HIV,” wrote the researchers. “Further efforts to improve outcomes along the HIV PrEP continuum of care for all MSM and to address racial/ethnic disparities […] would help achieve the nation’s goal of preventing new HIV infections.”


Photo of New York Pride 2019 by Brian Kyed on Unsplash

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