I live in the Midwest in a rural state. I have never seen horse meat on the menu, nor heard of anyone eating horse meat. Beef is what's for dinner.
However, I know an American who lived in Italy for a few years. She has sickle cell anemia, and she was diagnosed by an Italian doctor. The prescription? Eat horse meat. It is higher in iron than beef and it was recommended to her for that reason.
She wishes she could find horse meat in the U.S. She feels "best" eating horse meat rather than beef, but she eats beef liver as a substitute. She said that horse meat was actually quite good tasting.