In 2019, PrEP use among eligible heterosexually active adults was negligible (<1%), and approximately one in three heterosexually active adults was aware of PrEP. Overall, men reported lower PrEP awareness than did women. Awareness of PrEP was particularly low among Hispanic persons, with approximately one in six Hispanic women and approximately one in five Hispanic men having heard of PrEP. Awareness of PrEP was also low among persons who were not born in the United States, did not speak English well, or who resided in Puerto Rico. Given the high prevalence of HIV infection among Black persons, it is notable that their PrEP awareness was relatively higher than that among White or Hispanic persons. This might be attributable to HIV prevention campaigns tailored toward Black persons.

Awareness of PrEP and its potential to prevent sexually transmitted HIV infection is needed to end the HIV epidemic in the United States. PrEP use has the potential to reduce persistent racial, ethnic, and gender disparities in HIV infection observed among heterosexually active adults. In 2019, Black and Hispanic women accounted for 60.0% and 18.6% of new HIV diagnoses among women, respectively. Black and Hispanic men accounted for 61.2% and 20.3% of new HIV diagnoses attributed to heterosexual sex among men, respectively (1).

PrEP awareness might be low for multiple reasons, including limited tailored communications and infrequent patient-provider discussions about PrEP. In addition, few PrEP campaigns focus on heterosexual adults, particularly Hispanic persons. Although some prevention resources for heterosexual adults are inclusive of PrEP,^§§ most PrEP campaigns focus on men who have sex with men (MSM), which can reinforce stereotypes that PrEP is only intended for MSM (5). Because of stigma and gender norms, these stereotypes might interfere with marketing HIV prevention to some heterosexual Hispanic adults (6). Previous studies have indicated that heterosexual adults might not perceive themselves as being at risk for HIV infection or as candidates for PrEP (7).

Campaigns and interventions providing PrEP information and resources designed for heterosexual adults are limited. In 2021, CDC launched #ShesWell,^¶¶ which promotes PrEP among women; however, there are currently no national PrEP campaigns focused on all heterosexual adults at increased risk for HIV acquisition or heterosexual Hispanic men or women. Existing HIV interventions, such as Sister to Sister,*** which is geared toward Black women aged 18–45 years and implemented in primary care provider settings, could be expanded and tailored to other groups.

Although some PrEP resources are available in Spanish,^††† few PrEP materials are designed for specific groups of heterosexually active adults, including Hispanic persons, women, persons born outside the United States, and persons residing in Puerto Rico. Studies have also found that persons at high risk for HIV infection need messaging specifically customized for their population (8). Culturally competent PrEP materials and media campaigns geared toward heterosexual adults, including products tailored for heterosexual Hispanic persons, communicated through channels that might better reach Hispanic audiences, and which are available in Spanish, could increase PrEP awareness and use in this group (6). In addition, personalized PrEP campaign messaging might help heterosexual adults envision how PrEP could benefit them (9).

PrEP awareness might also be low because, despite CDC guidance, health care providers often do not discuss PrEP with heterosexual patients at increased risk for acquiring HIV (10). Primary care physicians and obstetricians and gynecologists can use routine visits and HIV and sexually transmitted infection testing encounters to educate their heterosexual patients about PrEP and screen for PrEP eligibility (5). Providers can assess barriers to PrEP use at multiple levels, including individual (e.g., side effects), interpersonal (e.g., judgment from others), community (e.g., caregiving duties), and structural (e.g., insurance and unstable housing) (10). Alternative PrEP options are emerging that allow ease of use, convenience, and confidentiality (e.g., vaginal rings and long-acting injectables) (10). Alternative modalities might broaden the appeal of PrEP among women (2) and encourage patient-provider discussions as part of sexual health assessments.

The findings in this report are subject to at least five limitations. First, data are not representative of all heterosexual men and women because the sample consists of low-income persons residing in 23 urban areas. Second, self-reported data are subject to recall and social desirability biases. Third, although awareness of PrEP is low, it is unknown whether participants had been exposed to existing PrEP campaigns. Fourth, PrEP awareness does not necessarily imply accurate knowledge or positive attitudes about PrEP. Persons might have heard of PrEP but might not be aware of their own eligibility. Finally, NHBS data are cross-sectional and do not support causal inference.

PrEP awareness among heterosexually active adults in the United States is low, especially among Hispanic men and women and persons residing in Puerto Rico. Although PrEP is not recommended for everyone, increasing awareness of PrEP in the general population could shape public attitudes and reduce stigma associated with PrEP and HIV (8,9). In addition to tailored, culturally appropriate campaigns for heterosexually active adults at risk for HIV infection, there are opportunities to increase awareness and use of PrEP through increased screening and patient-provider communication. Along with other preventive measures, increasing PrEP use among heterosexual persons is needed to end the HIV epidemic in the United States.