Rising PrEP Deserts: Racial Disparities in HIV Prevention Access Across Alabama and Kentucky

Recent analysis of Pre-Exposure Prophylaxis (PrEP) accessibility in the United States indicates shifting patterns in “service deserts,” where populations lack adequate access to HIV prevention medication. Data regarding the Southern United States reveals divergent trends in Alabama and Kentucky, with the latter showing significant racial disparities in the loss of healthcare access.

PrEP is a course of antiretroviral drugs used to prevent HIV infection in individuals who are at high risk. A service desert is defined as a geographic area where residents lack proximity to healthcare providers or pharmacies capable of prescribing and dispensing these medications.

In Alabama, the total population residing within PrEP service deserts has seen a slight increase. According to the research, this growth in underserved populations is primarily driven by a loss of accessibility within white communities. This trend suggests a broadening of the geographic gaps in prevention services across different demographic groups within the state.

The situation in Kentucky presents a different and more acute equity concern. The data indicates that the increase in the population living in PrEP service deserts is disproportionately affecting people of color. More than 60% of the population newly added to these service deserts in Kentucky are non-white.

These findings suggest that while access is declining in some areas of Alabama across broader demographics, the erosion of healthcare infrastructure in Kentucky is impacting marginalized communities more severely. This disparity points to systemic gaps in how HIV prevention services are maintained or distributed in the state.

The Southern United States has long been identified as the epicenter of the HIV epidemic in the U.S., characterized by higher rates of new infections and lower rates of viral suppression compared to other regions. The emergence of service deserts in this region complicates efforts to reduce new infection rates.

Access to PrEP requires not only the medication itself but also a consistent relationship with a healthcare provider for regular testing, and monitoring. When clinics close or pharmacies stop carrying specific medications, the resulting “desert” creates a barrier that often cannot be overcome by individuals without reliable transportation or flexible employment.

Public health experts note that the distribution of PrEP providers often mirrors existing healthcare inequities. In states like Kentucky, where rural healthcare infrastructure is already strained, the loss of a single provider can leave thousands of residents without a viable path to HIV prevention.

The disparity in Kentucky is particularly significant because non-white populations in the South often face intersecting barriers, including lower rates of health insurance coverage and higher levels of medical mistrust. The fact that over 60% of those losing access in Kentucky are non-white indicates that the most vulnerable populations are the first to lose essential preventive services.

In Alabama, the slight increase in the desert population among white communities suggests that the decline in access is not limited to traditionally marginalized groups, but is instead a symptom of a wider instability in the regional healthcare delivery system.

The shift in the PrEP landscape suggests that previous gains in medication availability are being offset by changes in provider availability. This may be due to a variety of factors, including changes in pharmacy networks, the closure of rural clinics, or shifts in how Medicaid and other insurance providers reimburse for PrEP services.

Addressing these deserts requires targeted interventions that go beyond the mere availability of the drug. Strategies often include the expansion of telehealth services, the use of mobile clinics to reach rural areas, and the implementation of pharmacy-led PrEP programs that reduce the need for frequent clinic visits.

As of May 29, 2026, the data emphasizes that the fight against HIV in the American South remains tied to geographic and racial equity. The divergence between Alabama’s general loss of access and Kentucky’s racially skewed loss of access provides a roadmap for where public health resources may be most urgently needed to prevent a resurgence of new infections.