One step closer to ending the HIV epidemic for some, not all

In an important step forward to address long-standing issues of health equity, the Biden administration issued new guidance to group health plans and health insurance companies regarding coverage of pre-exposure prophylaxis, better known as PrEP. Specifically, plans and insurers must now cover the cost of the PrEP medications as well as the laboratory services and office visits necessary for proper medical management. 

This policy is worth celebrating, as it will significantly improve access to often costly lifesaving HIV prevention treatment and care, but we must also acknowledge that we, collectively, have more work to do to reach the marginalized patients who are uninsured or confront foundational barriers to care.

At the outset, we must extend thanks and deep appreciation to the Biden administration for moving the needle forward on the fight to end HIV by beginning to address one of the most significant barriers to care: affordability. Since May 2020, there have been significant strides in increasing the availability of more affordable generic forms of PrEP that are the equivalent of Truvada.

However, some people are better served by utilizing a regimen of Descovy, another form of PrEP. Costs for Descovy are estimated to be around $2,000 for a 30 day supply. By addressing the prohibitive cost barriers to PrEP medications, we are strengthening the response to ending the HIV epidemic in the United States, while also encouraging more PrEP users among communities with higher HIV incidence.

HIV disproportionately impacts those who live at the intersections of multiple marginalized communities, especially LGBTQ communities of color. Currently, one in every two Black gay and bisexual cisgender men and one in four Latinx gay and bisexual men will be diagnosed with HIV in their lifetime. The prevalence of HIV is also profoundly felt in the transgender community, with almost half of all Black transgender women and an estimated 26 percent of Latinx transgender women living with HIV.

Although this expansion to cover the associated services needed to accompany PrEP is certainly worthy of praise, we must also acknowledge that there are members of our community whose lives will continue to be upended by today’s drug pricing policies, stigma, transphobia and homophobia. We need further investment by leaders at all levels to address barriers ultimately fueled by systemic inequity.

Health equity cannot be achieved until we address the systemic challenges within the health care system that exacerbate the rates of HIV incidence among marginalized communities and fuel inadequate access to health services. Part of this necessitates ensuring everyone who is eligible for PrEP has access, not simply those who are insured.

The U.S. Department of Health and Human Services (HHS) has taken steps to provide access to free PrEP medications to uninsured individuals through its Ready, Set, PrEP program. To date, however,  this well-intentioned program has been underutilized by the vulnerable population it was designed to serve. 

Ultimately, the long-term success of HIV prevention efforts will require a more comprehensive approach for communities hardest hit in the deep South, which accounts for 51 percent of new HIV cases annually and nearly half of all Americans without health insurance. One option, which Congress can advance now, is to provide Medicaid-level coverage to the more than 2 million uninsured adults who lack health care because their states chose not to expand this critical safety-net program. Addressing the gap in Medicaid coverage would not only help expand access to HIV prevention but help reduce racial health disparities.

Ending the HIV epidemic is within our grasp, but in order to achieve a future free of HIV, we must continue to center those who have been at the forefront of the crisis. We must urge government leaders to make HIV a public health priority, to invest in and strengthen public health programs, provide more funding for state and local health departments and community-based organizations, and make PrEP free and accessible to all, not just for some.

Alphonso David is the president of the Human Rights Campaign, the largest U.S. LGBTQ civil rights organization, he is the first civil rights lawyer and person of color to serve as its president.