Over the past decade, there has been a remarkable surge in the number of American young adults prescribed pre-exposure prophylaxis (PrEP), a medication regimen highly effective in preventing the transmission of human immunodeficiency virus (HIV). According to a groundbreaking study conducted by researchers at the University of Michigan Medical School, the frequency of PrEP prescriptions filled by individuals aged 18 to 25 has increased eightfold between 2016 and 2023. This notable upward trajectory reflects growing awareness and accessibility of PrEP among a demographic historically underrepresented in consistent HIV preventive care.
The study meticulously analyzed national pharmacy data, tracking oral PrEP prescriptions dispensed over a seven-year span. At the outset of this period, only 26 prescriptions per 100,000 young adults were recorded, but by the end of 2023, this rate had escalated dramatically to more than 208 per 100,000—representing a commitment from healthcare systems and patients alike to combat HIV transmission proactively. Nevertheless, while the rise in prescription rates is undeniably encouraging, the research also highlights critical challenges concerning adherence and sustained medication use within this vulnerable group.
An intriguing feature of the findings centers on the disparity in prescription rates between the younger subset (ages 18 to 21) and their slightly older counterparts (ages 22 to 25), with the former showing notably lower uptake. This phenomenon may be attributed to developmental, social, and healthcare access factors intrinsic to late adolescence and early adulthood. Compounding this issue is the observed decline in prescription refills’ duration—patients, on average, maintained their PrEP regimen for a shorter period by over two weeks compared to earlier years. Such inconsistencies in medication adherence raise concerns about the real-world effectiveness of PrEP outside of clinical trials.
The research team, led by Dr. Nina Hill, who balances roles as a general internist and pediatrician at the University of Michigan, underscores the complexity of navigating preventive care for young adults. This group often falls between pediatric and adult care models, leading to gaps in continuity and tailored health education. Furthermore, developmental psychology suggests that young adults may underestimate their susceptibility to sexually transmitted infections (STIs), including HIV, fostering less engagement with preventive healthcare services. Dr. Hill emphasizes the urgency of addressing these educational and systemic barriers to optimize the reach and impact of PrEP.
Critical to achieving consistent PrEP use is the sequence of medical interactions required for initiation and maintenance. Patients must first undergo HIV risk assessment, typically through provider consultations or validated online screening tools. Those deemed appropriate candidates then face an initial clinical evaluation involving tests not only for HIV but also other STIs, as well as assessments of renal function to ensure medication safety. Following prescription dispensing, rigorous follow-up every three to six months is essential, encompassing laboratory monitoring to detect any adverse effects and confirm ongoing HIV-negative status. Interruptions or irregularities in this continuum risk diminishing PrEP’s protective capacity.
The study also brings to light behavioral nuances around PrEP use, recognizing that some patients adopt event-driven or episodic dosing strategies. These regimens involve taking PrEP in anticipation of periods of sexual activity rather than daily use, demanding consistent access to medication and frequent healthcare contact. Ensuring that healthcare providers are equipped to counsel young adults on tailored PrEP strategies is paramount, especially when considering that irregular use may still confer significant but variable levels of protection depending on adherence fidelity.
Analysis of demographic data reveals further insights into geographic and gender-based patterns. Approximately one-third of the young adults receiving PrEP prescriptions resided in the southern United States—a region characterized by higher HIV incidence rates. Encouragingly, PrEP uptake in this area demonstrated the fastest growth during the study period, reflecting possibly intensified public health campaigns or shifts in regional healthcare infrastructure. While males composed the majority of PrEP users at 87%, the study acknowledges that women, particularly those with elevated HIV risk profiles, constitute an important but less represented group for PrEP intervention.
Medication formulation transitions over the study’s timeline play a relevant role. The initial PrEP drug, Truvada, introduced in 2012, became widely accessible as a generic in 2020, markedly reducing cost barriers. Additionally, Descovy emerged as a second oral PrEP option in 2019, though Truvada and its generic equivalents accounted for more than 70% of prescriptions. The arrival of injectable PrEP in 2021 represented an innovative advance in HIV prophylaxis, offering an alternative to daily pills. However, due to low uptake among young adults during the study period, injectable formulations were excluded from the analysis, indicating ongoing challenges in adoption and dissemination of newer treatment modalities.
The study further classified prescription origins by provider type, illuminating patterns in healthcare delivery. Nurse practitioners wrote 39% of PrEP prescriptions, underscoring their central role in preventive medicine and expanding access. Family medicine and general practitioners contributed 22%, while internal medicine physicians and physician assistants accounted for 14% and 11%, respectively. Notably, although emergency medicine physicians historically initiated few PrEP prescriptions, their involvement increased tenfold from 2016 to 2023, suggesting that emergency settings may be emerging as crucial points for initiating HIV prevention efforts among youth who might not otherwise engage in primary care.
This epidemiological research intersects with policy domains, particularly U.S. recommendations and insurance coverage mechanisms. Since 2019, the U.S. Preventive Services Task Force (USPSTF) has endorsed PrEP for adolescents and adults at increased risk for HIV. Furthermore, under the Affordable Care Act, most insurance plans are mandated to cover PrEP and related HIV screenings without patient cost-sharing if USPSTF criteria are met. Despite these provisions, ongoing legal challenges, such as the recent Supreme Court case Braidwood v. Kennedy concerning preventive care coverage, threaten to disrupt these protections and potentially impede access to lifesaving medications for vulnerable populations.
Dr. Hill and her colleagues advocate for enhanced dialogue among young adults, their healthcare providers, and trusted adults to dismantle stigma and misinformation surrounding sexual health. Expanding awareness about the efficacy of PrEP and streamlining pathways to access could bridge existing gaps. The multifaceted nature of HIV prevention necessitates a comprehensive approach that couples biomedical interventions with psychosocial support and structural reforms to sustain progress against the epidemic among young Americans.
This study’s findings represent a pivotal moment in understanding and confronting HIV risk among youth, emphasizing that increased prescription rates alone do not equate to effective prevention. Consistency in medication use, equity in healthcare access, and addressing developmental and systemic challenges remain crucial. As HIV continues to present global public health challenges, advancing tailored strategies and policy frameworks for young adults is indispensable for the ultimate goal of ending new HIV transmissions.
Subject of Research: People
Article Title: National Trends in HIV Pre-Exposure Prophylaxis Dispensing to Young Adults, 2016–2023
News Publication Date: 9-May-2025
Web References:
- https://link.springer.com/article/10.1007/s11606-025-09574-8
- https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis
- https://jamanetwork.com/journals/jama/fullarticle/2735342
References:
Hill N., Chua K.-P., He S. National Trends in HIV Pre-Exposure Prophylaxis Dispensing to Young Adults, 2016–2023. Journal of General Internal Medicine. DOI:10.1007/s11606-025-09574-8
Keywords:
Human immunodeficiency virus, Preventive medicine, Chemoprevention, HIV prevention, Young people, Adolescents, Adults, Antiretrovirals, Antivirals, Pharmaceuticals
