Oct 26, 2023 - News

Getting more Detroiters on HIV prevention medication

Illustration of a red AIDS awareness ribbon shaped like a "no" sign

Illustration: Sarah Grillo/Axios

Though the revolutionary HIV prevention medicine is covered by most insurers, there still are huge barriers to access in Detroit and across the United States.

Why it matters: There's no cure for HIV, but it's preventable and treatable thanks partly to pre-exposure prophylaxis, or PrEP.

The big picture: PrEP use climbed 4,400% from 2012 to 2022 nationwide, per data organization AIDSVu. But just 30% of people who could benefit from it took it as of 2021.

What they're saying: Allan Frank, an associate medical director at LGBTQ+ medical center Corktown Health, tells Axios there are three main problems slowing PrEP uptake.

  • Physicians need to be educated to offer most people PrEP, not just gay men, because they're not the only ones at risk — most people having sex outside a long-term monogamous relationship are at some risk, as well as injectable drug users. At Corktown Health, all patients are offered it but can opt out.
  • Most insurance and Medicaid programs cover PrEP, but the coverage processes can be difficult and lengthy and may not cover the best types of the medicine.
  • There also are racial inequities in access. "This extends beyond PrEP, for all medical needs … Black Americans access care less and there are social stigmas and barriers to this," Frank says.

By the numbers: In Michigan, seven out of 100,000 people, or 633 total, were newly diagnosed with HIV in 2021, the most recent year available from AIDSVu.

  • But the rate is higher in Detroit — 10 people per 100,000, or 334 total, as of 2020, the latest year available. The people diagnosed were 71.6% Black, 20.1% white and 4.8% Hispanic/Latinx.

Between the lines: The PrEP-to-need ratio is widely used to compare usage to the population's overall need. The lower the number, the higher the need.

  • In Wayne County, for every one person diagnosed with HIV in 2022, there were 7.2 people on PrEP — up from 4.2 in 2019.
  • Michigan's figure is 11.5, up from 6.6.

Context: While AIDSVu's PrEP data doesn't filter by race at the county level, across the Midwest, Black people accounted for 12% of PrEP use but 48% of new HIV cases.

The bottom line: "We can try to create … a welcoming, affirming clinic where persons of all backgrounds can feel welcome," Frank says. "There's posters up, flyers up that speak to a lot of different backgrounds. They are accepted and not judged."

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