Geographic Access to Preexposure Prophylaxis Clinics Among Men Who Have Sex With Men in the United States

Abstract

<i>Objectives.</i> To explore US geographic areas with limited access to HIV preexposure prophylaxis (PrEP) providers, PrEP deserts.<i>Methods.</i> We sourced publicly listed PrEP providers from a national database of PrEP providers from 2017 and obtained county-level urbanicity classification and population estimates of men who have sex with men (MSM) from public data. We calculated travel time from census tract to the nearest provider. We classified a census tract as a PrEP desert if 1-way driving time was greater than 30 or 60 minutes.<i>Results.</i> One in 8 PrEP-eligible MSM (108 758/844 574; 13%) lived in 30-minute-drive deserts, and a sizable minority lived in 60-minute-drive deserts (38 804/844 574; 5%). Location in the South and lower urbanicity were strongly associated with increased odds of PrEP desert status.<i>Conclusions.</i> A substantial number of persons at high risk for HIV transmission live in locations with no nearby PrEP provider. Rural and Southern areas are disproportionately affected.<i>Public Health Implications.</i> For maximum implementation effectiveness of PrEP, geography should not determine access. Programs to train clinicians, expand venues for PrEP care, and provide telemedicine services are needed.