Black Americans made up 38% of new HIV diagnoses in 2022 but only 14% of PrEP users in 2023. For every new HIV diagnosis among white Americans, there are 26 white PrEP users. For Black Americans, that number is 3. Free PrEP exists — the systems just aren't connecting people to it.
In 2022, Black Americans accounted for 38% of all new HIV diagnoses in the United States. They represent about 12% of the U.S. population.
In 2023, Black Americans represented 14% of PrEP users.
Read those numbers again. The community bearing the greatest burden of HIV has the least access to the medication that prevents it.
The PrEP-to-Need Ratio Tells the Real Story
Researchers use something called the PrEP-to-Need Ratio (PnR) to measure whether PrEP is reaching the people who need it. It's a simple concept: for every new HIV diagnosis in a group, how many people in that group are on PrEP?
The numbers are staggering:
- White Americans: 26 PrEP users per new HIV diagnosis
- Hispanic/Latinx Americans: 6 PrEP users per new HIV diagnosis
- Black Americans: 3 PrEP users per new HIV diagnosis
That's not a gap. It's a nine-to-one disparity between white and Black PrEP access relative to need.
Geography Compounds Race
The Southern U.S. — where 52% of new HIV diagnoses occur — has only 10 PrEP users for every new diagnosis, compared to 22 in the Northeast. Within the South, the disparity intensifies by race: Black Southerners account for 48% of the region's new HIV diagnoses but only 21% of PrEP users.
In the Midwest, it's even worse: Black Americans represent 48% of new HIV diagnoses but only 12% of PrEP users.
The states with the worst PrEP-to-Need Ratios for Black Americans — with fewer than 2 PrEP users per new diagnosis — include Mississippi, Alabama, Arkansas, North Dakota, South Dakota, and Iowa.
Access shouldn't depend on where you live or what you look like.
MISTR provides free PrEP — medication, labs, and consultations — in all 50 states, with no discrimination. Start a free consultation today.
Start Free PrEP with MISTR →Using this code at signup helps us achieve our mission of getting free PrEP out to all who need it.
This Isn't About Awareness
It's tempting to frame this as a "knowledge gap" — if only more people knew about PrEP, they'd take it. But the research doesn't support that. Studies consistently show that awareness of PrEP is high across racial groups. The barriers are structural:
- Insurance gaps: Black Americans are more likely to be uninsured or underinsured, particularly in Southern states that haven't expanded Medicaid.
- Provider deserts: Many majority-Black communities, especially in rural areas, have no PrEP-prescribing provider within a reasonable distance.
- Medical mistrust: Decades of documented medical racism — from the Tuskegee syphilis experiment to ongoing disparities in care — have created justified skepticism of healthcare institutions.
- Stigma: HIV stigma intersects with anti-LGBTQ+ stigma and racial stigma in ways that make seeking PrEP feel high-risk in certain communities.
- Cost perception: Even though PrEP is free for most people, the perception that it's expensive keeps people from asking about it.
What's Actually Available — Right Now, for Free
Every pathway to free PrEP is open to every American regardless of race, but connecting people to these pathways requires meeting them where they are:
Gilead Advancing Access: Free Truvada, Descovy, or Yeztugo for any uninsured person earning under roughly $60,300/year. No immigration status requirement. Phone: 1-800-226-2056.
Telehealth: Platforms like MISTR eliminate the need to visit a clinic — no waiting room, no face-to-face interaction with a provider who might be judgmental, no transportation barriers. Everything happens through your phone.
Community health centers: Over 1,400 Federally Qualified Health Centers (FQHCs) provide PrEP on a sliding-fee scale. Find one at findahealthcenter.hrsa.gov.
Private. Judgment-free. Free.
MISTR handles PrEP entirely through your phone — no clinic, no waiting room, no awkward conversations. Medication shipped discreetly to your door.
Start Free PrEP with MISTR →Using this code at signup helps us achieve our mission of getting free PrEP out to all who need it.
What Needs to Change
Free PrEP programs exist, but they're not reaching the communities that need them most. Closing the racial PrEP gap requires investment in community-based outreach, culturally competent providers, and systems designed around the people they're supposed to serve — not the other way around.
In the meantime, if you or someone you know could benefit from PrEP, the pathways below are real, free, and available today.
Find every free PrEP option in your state: FreePrEP.org State Directory →
Start free PrEP today — 10 minutes, zero cost.
MISTR provides free PrEP in all 50 states. Consultation, labs, medication — all at $0, insured or uninsured.
Start Free PrEP with MISTR →Using this code at signup helps us achieve our mission of getting free PrEP out to all who need it.
Frequently Asked Questions
Why is PrEP use so much lower among Black Americans?
Structural barriers including higher rates of uninsurance (especially in Medicaid non-expansion states), fewer PrEP-prescribing providers in majority-Black communities, medical mistrust rooted in historical exploitation, and intersecting stigmas around HIV, sexuality, and race.
Is PrEP free for everyone regardless of race?
Yes. Every free PrEP pathway — insurance mandates, Gilead Advancing Access, state programs, telehealth platforms — is available to all Americans regardless of race, ethnicity, or immigration status.
What is the PrEP-to-Need Ratio?
It measures how many people are on PrEP for every new HIV diagnosis within a group. A higher ratio means better coverage. White Americans have a PnR of about 26; Black Americans have a PnR of about 3.