At a pharmacy in Iowa, a 42-year-old Black gay man couldn’t find a medication he needed. The pharmacist, a white woman, told him they didn’t stock that medication. But while he waited to pay for his other purchases, he saw another customer place the medication he just asked for on the counter.
“I felt really bad,” he said. “I think (when) people place their biases alongside their profession, it makes it difficult to access (health) services.”
One of these services include PrEP, or preexposure prophylaxis, a highly effective prescription medication that prevents the spread of HIV.
Despite being disproportionately affected by HIV, Black gay and bisexual men have one of the lowest rates of PrEP usage across all age groups. Many of them live in the South, which has the highest number of people living with HIV in the U.S. but very low PrEP uptake due to stigma, cost and homophobia. Other barriers include lack of trust in the health care system, discrimination, poverty and limited physician knowledge about PrEP.
PrEP faces significant barriers for widespread use among the most vulnerable populations. In 2022, only 36% of the 1.2 million people who could benefit from PrEP were prescribed the medications. As public health researchersstudying why Black gay and bisexual men have low access to PrEP in Iowa – a rural state with growing rates of HIV infection, especially among sexual and gender minorities – we recently published a study that highlighted some ways to improve prevention.
A report from the Iowa Department of Health and Human Services found that only a little over 23% of people in need of PrEP in Iowa had active prescriptions in 2021. Another report found that a state program designed to expand PrEP access through telehealth, called TelePrEP, saw significant disparities in treatment initiation. Only 10% of the people who started PrEP through the program were Black. In contrast, 83% of those who initiated TelePrEP were white.
To better understand the factors that hinder or help Black gay and bisexual men in Iowa access PrEP, we interviewed 12 HIV-negative community members about their experiences with the drug. They were between 20 and 42 years old and lived in Johnson and Black Hawk counties, where there are some of the highest rates of HIV infections in the state. We recruited them through dating apps, social media platforms and local organizations.
At a pharmacy in Iowa, a 42-year-old Black gay man couldn’t find a medication he needed. The pharmacist, a white woman, told him they didn’t stock that medication. But while he waited to pay for his other purchases, he saw another customer place the medication he just asked for on the counter.
“I felt really bad,” he said. “I think (when) people place their biases alongside their profession, it makes it difficult to access (health) services.”
One of these services include PrEP, or preexposure prophylaxis, a highly effective prescription medication that prevents the spread of HIV.
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