Date of Award

January 2026

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Gregg Gonsalves

Abstract

Pre-exposure prophylaxis (PrEP) is an effective tool at minimizing HIV infection following exposure. However, coverage rates remain low, particularly for Black and Hispanic/Latino individuals. H.R. 1, which may limit access to PrEP, has the potential to lead to excess HIV incidence. This analysis estimates that a 1% loss in PrEP coverage is associated with 211 additional cases for men who have sex with men (MSM), 68 cases among heterosexuals, and 17 cases among persons who inject drugs (PWID). This study also finds that Black and Hispanic MSM and Black heterosexuals are disproportionately impacted at low levels of PrEP coverage loss. However, at extreme levels of PrEP coverage loss, White MSM and heterosexuals faced extremely large estimates of additional HIV cases. These results suggest that at low levels of PrEP coverage loss, existing disparities in HIV incidence remain. However, at higher levels of PrEP coverage loss, White communities may lose the protections afforded by high PrEP coverage rates, as they have the potential to experience more significant drops in coverage. Researchers and state-level policymakers should monitor PrEP coverage rates after the implementation of H.R. 1 to determine which communities may experience sudden spikes in case numbers.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 09/16/2028

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