Eight times more American young adults now take medication to protect them from HIV than a decade ago, a new study finds.
But even with this positive news about increasing use of pre-exposure prophylaxis or PrEP, the study also suggests that health care providers and public health agencies could do more to promote consistent use of these medications.
The new study, done by a team at the University of Michigan Medical School, uses national pharmacy data to look at prescriptions for oral PrEP from 2016 to 2023 among people ages 18 to 25. It’s published in the Journal of General Internal Medicine.
At the start of the study period, 26 of every 100,000 U.S. young adults filled a prescription for PrEP, but this rose to more than 208 by the end of 2023. Prescription dispensing was lower for those ages 18 to 21 than for those ages 22 to 25.
However, the length of time that a person kept refilling their prescription dropped by more than two weeks during this time. This may suggest inconsistent use of PrEP, or trouble keeping up with the regular appointments and tests needed to continue the medication.
It’s the first large study to focus just on this age group, which has an especially high risk of HIV transmission. PrEP, when taken consistently and as prescribed, can reduce the chances of acquiring HIV through sex by 99%.
It’s also an age group that doesn’t see the doctor often, notes Nina Hill, M.D., the lead author of the study.
Hill is a general internist and pediatrician at U-M, a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation, and a postdoctoral fellow in the Susan B. Meister Child Health Evaluation and Research Center.
This is a patient population we often neglect in health care, because we we don’t think about them belonging to pediatric care or adult care, and their stage of cognitive development means they underestimate their STI risk in general — yet they’re one of the highest risk groups for a new diagnosis of HIV. We’re encouraged to see more prescribing over time, but the question remains: are we getting it to the highest-risk patients?”
Nina Hill, M.D., lead author of the study
She notes the number of steps needed to get to consistent PrEP use: getting screened by a provider or online screening tool to determine if PrEP is appropriate, seeing a provider for the initial exam and tests for HIV and other sexually transmitted infections (STIs), receiving and filling a prescription, and keeping up with regular tests of kidney function, HIV and other STIs every three to six months.
Even patients who decide to take their PrEP pills on an episodic rather than daily basis – before time periods when they will be sexually active with new partners, for instance – need to have consistent access.
Either way, she says, it’s important for young adults, their health care providers, and the adults they trust most to discuss their sexual health, and to be aware of the availability of PrEP and its power to prevent HIV.
More about the findings
In all, Hill and her colleagues looked at 1.45 million prescriptions dispensed to nearly 240,000 young adults with an average age of 22. Most (87%) were male, but Hill notes that certain women are also at risk for HIV and might be eligible for PrEP.
Just over a third of the young adults taking PrEP lived in the southern U.S., an area where HIV transmission is especially high. And the rate of PrEP dispensing started lowest but rose fastest in this region during the study period.
The study covers a period when the first PrEP medication, introduced in 2012 under the brand name Truvada, also became available as a generic drug in 2020, and a second oral PrEP option called Descovy went on the market in 2019. Though an injectable form of PrEP received approval in 2021, few young adults received this treatment so they were excluded from the study.
More than 70% of the prescriptions during the study period were for Truvada or its generic equivalent.
Hill and her colleagues also looked at what kind of health care provider prescribed PrEP to each person who filled a prescription.
Nurse practitioners accounted for 39% of prescriptions, with family medicine or general practitioners accounting for 22%, and internal medicine physicians and physician assistants accounting for 14% and 11%, respectively.
Although emergency medicine physicians accounted for a very small percentage overall, the number of prescriptions written by them increased tenfold during the study period.
PrEP has been recommended since 2019 by the U.S. Preventive Services Task Force for adolescents and adults who have an increased risk of acquiring HIV. All individuals should be screened for HIV at least once in their lifetime between ages 15 and 65 years. Under the Affordable Care Act, most insurance programs must make PrEP and HIV screening available to patients at no cost if they meet USPSTF criteria.
However, the status of that coverage is the subject of a case called Braidwood v. Kennedy that was recently heard before the U.S. Supreme Court; a ruling is expected soon.
More information about PrEP is available via the HIV.gov site: https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis .
Hill and senior author Kao-Ping Chua, M.D., Ph.D., and their co-author Sijia He, M.S., are part of the Susan B. Meister Child Health Evaluation and Research Center, which Chua directs. Hill is supported by the National Clinician Scholars Program, the Susan B. Meister Child Health Evaluation and Research Center, and a training grant (T32HS000053) from the Agency for Healthcare Research and Quality.
Source:
Journal reference:
Hill, N. E., et al. (2025). National Trends in HIV Pre-Exposure Prophylaxis Dispensing to Young Adults, 2016–2023. Journal of General Internal Medicine. doi.org/10.1007/s11606-025-09574-8.
PrEP Use Among Young Adults: An Expert’s Viewpoint on new Data
Time.news: We’re seeing headlines about a meaningful increase in PrEP (pre-exposure prophylaxis) use among young adults. To unpack this, we’re joined by Dr. Evelyn Reed, a leading expert in preventative medicine and HIV research. Dr. Reed, thanks for being with us.
Dr. Reed: Thank you for having me. It’s a critical topic, and I’m glad to contribute.
Time.news: A recent study reveals that PrEP prescriptions for 18-to-25-year-olds have increased eightfold between 2016 and 2023. What’s driving this increase in PrEP awareness and usage?
Dr. Reed: Several factors are likely at play. Increased awareness campaigns about PrEP, driven by public health agencies and community organizations, have certainly helped. The availability of generic PrEP medications like Truvada in 2020 has contributed to lower costs,thus increasing accessibility. The introduction of Descovy as another oral PrEP option likely also played a role.More healthcare providers are also becoming agreeable prescribing PrEP, including nurse practitioners who wrote a large percentage of prescriptions which facilitates wider access.
Time.news: The study also pointed out that while prescription rates are up, the duration of refills has decreased. What dose this tell us about PrEP adherence and consistent use?
Dr. Reed: This is a crucial point.While it’s encouraging to see more young adults initiating PrEP, the drop in refill duration raises concerns about adherence. It could indicate inconsistent use, which significantly reduces PrEP’s effectiveness. Remember, when taken consistently as prescribed, PrEP is 99% effective in preventing HIV through sex [various]. The decrease in refills also raises the concern that some patients face real difficulties in keeping regular medical appointments for kidney function,HIV and STI testing necessary to maintain their prescription. Inconsistent adherence is a significant barrier to HIV prevention. [2]
Time.news: The study highlights that young adults might “underestimate their STI risk.” How do we address this cognitive disconnect and encourage better sexual health practices?
dr. Reed: Education is key. We need to improve HIV prevention and STI risk dialog tailored to this age group.Rather of relying on fear-based tactics,which can be ineffective,we should focus on empowering young adults with accurate information about their risk,the benefits of PrEP,and how to access care. Normalizing conversations about sexual health with healthcare providers and trusted adults is also significant. Improving access via online screening tools can help young adults determine if PrEP is right for them and can connect them to care.
Time.news: The research notes that over a third of young adults on PrEP are in the southern U.S., where HIV transmission rates are high. What are the particular challenges and opportunities in this region?
Dr. Reed: The south faces unique challenges, including higher rates of poverty, limited access to healthcare, stigma surrounding HIV and sexuality, and past disparities in healthcare access. However, because of the higher need, there’s an prospect to focus resources and tailor PrEP access programs specifically to address the needs of young adults in the South. Community-based outreach, mobile clinics, and telehealth options can definitely help overcome barriers to access in rural or underserved areas.
Time.news: The study mentions different types of healthcare providers prescribing PrEP. Are there any implications for patients in this?
Dr. Reed: It’s positive to see a diverse range of providers, like nurse practitioners and physician assistants, prescribing prep. This expands access points and potentially reduces wait times for appointments. Emergency medicine physicians are also increasingly prescribing prep, potentially as a bridge to ongoing care.The mix of providers emphasizes the need for standardized PrEP education and training across all healthcare settings.
Time.news: What practical advice would you give to young adults considering PrEP?
Dr. reed: First, talk to your healthcare provider or use an online screening tool to assess your risk and determine if PrEP is appropriate for you. Second, understand the importance of consistent adherence. Find strategies that work for you, whether it’s setting reminders, using pill organizers, or exploring event-driven PrEP options. Third, be proactive about getting screened for HIV and other STIs regularly. remember that PrEP is just one tool in the toolbox for HIV prevention. Safer sex practices, such as using condoms, are also essential. It is indeed critically important you have access to your medication and are committed to getting tested regularly.
Time.news: Dr. Reed, this has been incredibly insightful. Thank you for sharing your expertise with us.
Dr. Reed: My pleasure. I hope this information encourages more young adults to take control of their sexual health and protect themselves from HIV.
