Pre-exposure prophylaxis (PrEP) is an efficacious HIV prevention strategy. Using a national database of publicly-listed clinics that prescribe PrEP in the contiguous United States, we explored ‘deserts’ with low access to PrEP as defined by driving time to the closest clinic.
MSM population estimates, county urbanicity, and PrEP provider data were sourced from public data and a national database of publicly listed PrEP providers. Using geographic information systems (GIS), we proportionally allocated county-level MSM estimates and a national PrEP-eligibility estimate to census tracts, areas with a median of 4000 persons. We mapped PrEP providers and calculated travel time, based on ideal traffic conditions, from census tract centroids to the nearest PrEP providers. We classified tracts as being part of a ‘PrEP desert’ based on 30-minute and 60-minute drive travel times to the nearest PrEP-providing clinic.
Over one-fifth of MSM (620,150/2,904,089; 21%) lived in census tracts farther than a 30-minute drive away from the nearest PrEP-providing clinic, and 8% (228,391/2,904,089) lived farther than a 60-minute drive. Similar proportions of PrEP-eligible MSM (136,718/607,711; 23%) lived farther than a 30-minute or (49,883/607,711, 8%) 60-minute drive from the nearest PrEP-providing clinic. Using a 60-minute definition of PrEP desert, two-thirds (65.5%) of all deserts were in micropolitan or noncore areas, accounting for 49.2% (28,874) of all PrEP-eligible MSM in deserts. Using the same cutoff, seven of nine geographic census divisions had more than 15,000 MSM living in deserts and six of nine divisions had more than 5,000 PrEP-eligible MSM living in deserts.
Substantial geographic areas within the United States do not have nearby, publicly-listed clinics that prescribe PrEP. Large numbers of MSM have limited access to PrEP, living in ‘deserts’ that require substantial driving time to care. Our estimates of the proportion of MSM living in PrEP deserts are conservative, because driving time calculations use ideal traffic conditions. Moreover, many PrEP-eligible MSM may not have access to a car, which could substantially increase transit times. Given a requisite of four annual visits per year for PrEP care, substantial travel time to care could limit PrEP scale-up. HIV prevention programs must consider travel burden and transportation access as a key part of expansion to more effectively reach both urban and rural MSM in need.