One of CHARM’s T32 fellows, Dion Allen, Ph.D., M.Sc., has published work initially supported by a CHERISH pilot grant, advancing national understanding of the policy and clinical factors that shape women’s access to HIV prevention.

Two recent studies led by Dr. Allen, a postdoctoral associate at the University of Miami Miller School of Medicine, examine this gap through two perspectives: the role of Medicaid expansion and the influence of key healthcare settings on women’s engagement in PrEP care. 

Examining the Impact of Medicaid Expansion 

The first study evaluated whether Medicaid expansion under the Affordable Care Act improved PrEP uptake for women. Using a decade of publicly available data from 2012–2021, Dr. Allen and colleagues assessed changes in PrEP rate and PrEP-to-need ratio across states with and without expansion. 

States that adopted Medicaid expansion saw clear gains in PrEP use overall. These improvements, however, were not evenly distributed. While men experienced substantial increases in PrEP uptake, women saw only modest gains that did not reach statistical significance. The findings suggest that broader policy approaches must be paired with strategies that specifically address women’s pathways to HIV prevention. 

Assessing Opportunities Within Healthcare Settings 

A second analysis examined whether access to mental health services, substance use disorder (SUD) treatment centers, and family planning clinics was associated with PrEP uptake among women. These settings serve many women who could benefit from HIV prevention, yet the study found limited evidence that increased availability translated into higher PrEP use. 

For men, greater availability of mental health and SUD treatment centers was associated with small increases in PrEP use. For women, there was no measurable improvement, and states with more family planning clinics saw a decline in PrEP rate. These findings point to missed opportunities to integrate HIV prevention into routine care settings that women regularly rely on. 

Informing the University’s Continued Work in HIV Prevention 

Together, the studies contribute new national-level evidence that supports the University’s broader efforts to advance HIV prevention and address disparities in access to care. The results highlight opportunities to strengthen clinical workflows, expand provider training, and develop interventions grounded in women’s lived experiences and healthcare utilization patterns.

"This work shows how much opportunity there is to strengthen PrEP delivery for women across the country. I’m excited to continue building evidence and collaborating with clinics, providers, and communities to help close these gaps," said Dr. Allen.

While gaps in PrEP uptake persist, these analyses offer guidance for future public health strategies aimed at improving access and reducing inequities in HIV prevention for women.

Written by Deycha Torres Hernández, published on November 24, 2025.