What Is the Effect of Medicaid Expansions on Preexposure Prophylaxis for HIV Prevention Use among Women?

Pre-exposure prophylaxis (PrEP) is a key biomedical tool for combatting HIV spread, but women account for only 5% of users. Between 2015 and 2019, men saw a 9% decrease in new HIV diagnoses, while rates among women remained constant. Using a difference-in-differences regression model and state level HIV surveillance data (utilizing sex assigned at birth) reported by AIDSVu from 2012 to 2021, we examined the impact of Medicaid expansions under the Affordable Care Act on PrEP outcomes. The study revealed that Medicaid expansions were associated with better PrEP outcomes overall, with increases of 18.9% in PrEP rate and 40.4% in PrEP-to-need ratio for every state that expanded Medicaid. Males experienced better outcomes with a 43% increase in PrEP-to-need ratio, while females saw a 15.6% increase that was not statistically significant. Medicaid expansion improves PrEP access for all, however more targeted strategies are needed to increase PrEP uptake among women vulnerable to HIV.