PPrEP for the End of the HIV/AIDS Epidemic
By Carl Schmid
The end of the HIV/AIDS epidemic in the United States could soon be in sight.
While we don't yet have an HIV vaccine, we have drugs that are nearly 100% effective in preventing people from contracting HIV. These medicines are the cornerstone of a prevention approach called pre-exposure prophylaxis, or PrEP. And since the start of 2021, PrEP drugs are supposed to be available at no out-of-pocket cost to most patients with private insurance.
Yet obstacles stand in the way of implementing this highly effective prevention tool. These include awareness, stigma, and cost -- yes, cost, despite the legal requirement that these drugs be provided free to patients. We must push forward on all these fronts to eliminate this virus once and for all.
There are 1.2 million Americans at substantial risk of contracting HIV, according to the CDC. But less than a quarter of that population is taking PrEP. Members of racial and ethnic communities, along with women, have far less access to this preventative regimen. In 2018, white Americans were six times more likely to be on PrEP than Black Americans -- and five times more likely than Latino Americans.
Those disparities persist despite the fact that 64% of new HIV cases among men who have sex with men occur in minority groups.
Patients of color are also less likely than white patients to talk to their doctors about PrEP -- in part because of the stigma around HIV.
Insurers aren't helping either. Many at-risk Americans may not be aware that insurers should cover PrEP drugs without any cost to patients. I recently conducted spot checks to see which insurers were following these federal guidelines. Insurers from Georgia, Ohio, Washington, and more have failed to comply by keeping PrEP drugs in less accessible tiers or categories, raising the barrier to access.
Last year, the Biden administration gave insurers 60 days to eliminate the costs of services associated with prescribing PrEP. This is an essential step, as patients must be tested for HIV and other pre-existing conditions before starting PrEP.
The move to cover PrEP and its associated services enormously benefits at-risk communities, but it still leaves a massive gap: the uninsured. The CDC estimates that at least 200,000 uninsured people are at risk for contracting HIV -- nearly one quarter of the total at-risk population.
Federal programs can play a major role in increasing awareness, reducing stigma, and providing PrEP to the uninsured. For instance, community health centers have already shown remarkable results connecting with people in need of PrEP.
But these programs are in their infancy, so the government must ramp them up. The federal government must also increase CDC funding for local PrEP outreach programs, particularly in the South, where stigma is highest.
We are on the cusp of having HIV go the way of smallpox and polio. The tragedy and loss can finally be a thing of the past if the government makes the right moves now.
Carl Schmid is executive director of the HIV+Hepatitis Policy Institute, which promotes quality and affordable health care for people living with or at risk of HIV, hepatitis or other serious and chronic health conditions. Follow the HIV+Hepatitis Policy Institute on Twitter: @HIVHep
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