PrEP use remains low among people under 25, experts urge training

PrEP has been available for adolescents old enough to weigh at least 35 kilograms, or 77 pounds, yet the medication still reaches too few people under 25. That gap matters because youth ages 13 to 24 accounted for 19% of new U.S. HIV diagnoses in 2021, while only 20% of 16- to 24-year-olds who were indicated for PrEP were prescribed it.

The problem is not a lack of evidence. The Centers for Disease Control and Prevention says PrEP is medicine that lowers the chance of getting HIV for adults and adolescents without HIV who may be exposed through sex or injection drug use, and its guidance tells clinicians to inform all sexually active adult and adolescent patients about it. The Food and Drug Administration expanded Truvada’s PrEP indication to at-risk adolescents weighing at least 35 kilograms in 2018, underscoring that prevention is meant to start before exposure, not after risk has already turned into infection.

Experts say the bottleneck is often inside the health system. The American Academy of Pediatrics has said pediatricians can play a key role in HIV testing and prophylaxis for adolescents and young adults, but a 2025 AAP study found barriers that still block access: confidentiality concerns, stigma, provider hesitation to discuss sexual health with minors, limited school-based sex education, clinic access problems and low health literacy. For teens and young adults who may already be navigating sexual debut, new partners and inconsistent condom use, those barriers can turn a proven prevention tool into a missed opportunity.

The CDC’s own numbers show how uneven the uptake has been. In 2020, only about 16% of people ages 16 to 24 who were indicated for PrEP had been prescribed it, compared with about 27% of those ages 25 to 34 and about 30% of those ages 35 to 44. By 2022, for the first time, more than one-third of people in the United States who could benefit from PrEP had been prescribed it, but younger people were still lagging behind.

That lag has national consequences. CDC paused PrEP coverage reporting in 2024 while updating estimates, then said staffing reductions in the Division of HIV Prevention prevented it from resuming the reporting. That makes it harder to track whether younger patients are being reached, even as newer options such as injectable lenacapavir, approved in June 2025, may offer another way to improve prevention if clinicians are trained to offer it.