HIV preexposure prophylaxis uptake remained low among US youths, with disparities by age, sex, region, and policy.
HIV preexposure prophylaxis use remains strikingly limited among adolescents and young adults in the USA who may benefit from it, according to a retrospective cohort study of a national claims database. The analysis included 100,536 commercially insured youths aged 13 to 21 years with diagnostic codes indicating high risk sexual behavior or bacterial sexually transmitted infections, including gonorrhea, chlamydia, and syphilis.
During follow up, only 1,598 youths filled a prescription for HIV preexposure prophylaxis, corresponding to an incidence rate of 6.9 per 1,000 person years. These findings suggest that, even among youths with documented clinical indicators of potential benefit, uptake remains low.
Disparities in HIV Preexposure Prophylaxis Use
Marked differences in HIV preexposure prophylaxis initiation were observed across demographic and geographic groups. Male youths were substantially more likely to receive PrEP than female youths, and older participants were more likely to start treatment than minors. Compared with youths under 18 years, those aged 20 to 21 years had a significantly higher likelihood of initiation.
Regional variation was also evident. Youths living in the South and Midwest were less likely to initiate HIV preexposure prophylaxis than those in the Northeast. In addition, state level LGBTQ+ protective laws were associated with higher uptake, suggesting that policy context may influence access to HIV prevention services.
The findings point to persistent inequities affecting youths who could benefit from HIV preexposure prophylaxis, particularly minors, females, and those living in regions with lower uptake.
Clinician Engagement May Be a Missed Opportunity
The study also highlighted a possible gap in clinician engagement. Pediatricians documented conditions suggesting potential benefit from PrEP in 141 of the 1,598 youths who later filled a prescription, yet they accounted for only 76 of those filled prescriptions. This pattern may indicate missed opportunities to translate risk recognition into preventive prescribing.
The authors concluded that improving HIV preexposure prophylaxis uptake among youths will likely require a broader response that addresses geographic disparities, legal and policy barriers, and clinician involvement. Expanding equitable access to HIV prevention in adolescent populations may be essential to reducing onward transmission.
Reference
Venturelli N et al. HIV Preexposure Prophylaxis Uptake Among US Youth in a National Claims Database. JAMA Pediatrics. 2026; doi:10.1001/jamapediatrics.2026.0682.
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