HIV PrEP Is Only Available at 1 in 3 New England Colleges and Universities

The Bottom Line

Pre-exposure prophylaxis (PrEP) reduces HIV incidence and infection by more than 90%, but it isn’t available at 1 in 3 student health services in New England — and those institutions that did offer PrEP had low prescription rates. Increasing access to this preventative medical intervention is vital in decreasing HIV in college-aged individuals.  

Context

The time period of highest HIV risk coincides for many with college age. Because student health services are the primary source of healthcare for students, they are a unique resource to tap when it comes to treatment and prevention. Low rates of PrEP coverage among this population would indicate that PrEP is not widely available at colleges and universities. Yet, prior to this research, there is little existing peer-reviewed data tracking that rate of availability.

Study Objective

To determine HIV PrEP availability at New England colleges and university student health services.

The Details

Researchers from Boston Medical Center in collaboration with Boston Health Care for the Homeless Program and the Division of Infectious Diseases at Beth Israel Deaconess Medical Center surveyed directors of 143 eligible student health services at two- and four-year undergraduate institutions in New England. Researchers sent a detailed 34-item survey that addressed health center staffing and utilization, PrEP knowledge, barriers and facilitators to PrEP prescribing, and availability of PrEP and other sexual health services.  

Findings

Of the 143 eligible schools, 50 student health center directors completed the researchers’ survey, and results showed that 64% of the institutions offered PrEP either with or without a formal program. Those that did offer it reported starting PrEP for an average of 2 per 1,000 students; they oversaw care of an average of 0.7 per 1,000 students per year who started PrEP elsewhere.

Schools that did not offer PrEP cited insurance coverage, clinical monitoring requirements, and staffing or time constraints as the primary barriers. Some schools also cited concern about parental notification and lack of institutional support related to religious affiliation.

PrEP was available at more four-year than two-year schools and more private than public schools.

Researchers note that the number of students starting and continuing on PrEP is much lower than the number of students who would likely benefit from PrEP. Researchers recommendations include but are not limited to: expanding student insurance plans and enhancing patient navigation resources to, for example, show students how to request that their parents not be privy to their health information. They also recommend disseminating educational resources about PrEP guidelines, in party by partnering with LGBTQIA+ centers and organizations to help increase student awareness. However, it’s key to note that partnerships with student groups across the board would be helpful, as all sexually active people could benefit from PrEP information.

Pull Quote

“Almost half the respondents not offering PrEP reported that referring students top outside PrEP providers would be the most feasible implementation strategy for their health center…However PrEP availability on campus may be the most student-centered model, potentially reducing travel and other barriers to care.”