Awareness Without Counseling: Missed Opportunities for Clinical Communication on Pre-Exposure Prophylaxis of Reproductive Age Females in the USA

Abstract

Background: Pre-exposure prophylaxis (PrEP) has emerged as a highly effective strategy for human immunodeficiency virus (HIV) prevention, yet uptake remains disproportionately low among women and racially minoritized populations. This study aims to understand how PrEP counseling in clinical settings has changed over time and how it affected PrEP awareness in reproductive age females in the USA.

Methods: Using the National Survey of Family Growth data set, this was a cross-sectional study of two survey cycles (2017–2019 (n = 6,141) and 2022–2023 (n = 5,586)). The primary outcome was awareness of PrEP, with secondary outcomes including reported provider counseling on PrEP, counseling and prescribing of contraception, and current use of contraception. Analyses were performed with Stata 18.5 (StataCorp, College Station, TX), and accounted for complex survey design.

Results: Between 2017–2019 and 2022–2023, respondent reported awareness of PrEP increased from 31.8% to 36.6% (odds ratio (OR) = 1.24; 95% confidence interval (CI) = 1.04–1.47), while reported provider counseling rates remained unchanged (5.2% vs. 4.8%; OR = 0.91; 95% CI = 0.70–1.19). In 2022–2023, awareness among Hispanic women was significantly lower (24.9%) than among non-Hispanic white (42.0%) respondents (OR = 0.46; 95% CI = 0.36–0.58).

Conclusions: This research demonstrates that public awareness of PrEP increased though provider counseling rates were unchanged. However, when accounting for language preference, Spanish-speaking women had less awareness than English speakers. This raises the concern that provider-patient interactions are ineffectively utilized, especially in non-English speakers, and highlights the need to optimize healthcare systems.