What About People Who Can’t Access PrEP In The First Place?
December is AIDS Awareness Month, and what better time for the White House to announce their “Ready, Set, PrEP” plan, which is designed to provide 200,000 uninsured people with free PrEP over the next decade. PrEP costs about $2,000 a month without insurance, making it unattainable for many.
The CDC released data, indicating that only 18% of people at risk of contracting HIV got a prescription in 2018.
PrEP requires a prescription… and multiple doctors visits and tests, which equals $$$.
The White House’s plan would make sense if obtaining PrEP was as simple as just going to the pharmacy.
California signed SB 159 into law this fall, removing the requirement of a prescription to obtain PrEP and PEP. But in all other 49 states, you need to see a doctor (or nurse practitioner) first and get a prescription.
And it’s not only a prescription; the CDC mandates that patients get several blood tests before going on PrEP, with subsequent testing every three months while on the medication.
How are uninsured folks expected to be able to afford all of these visits and tests out-of-pocket? The White House plan simply does not address this.
Providers must be knowledgable, trustworthy, and willing to prescribe PrEP in the first place.
Then there’s the physical ability to access HIV preventative care. The #WeNeedAButton campaign has illustrated the fact that even in places as seemingly progressive as New York City, there are providers who refuse to prescribe PrEP and PEP. But in the rural south, the situation is much more bleak. The region accounts for more than half of new HIV diagnoses, but is home to only around 25% of the nation’s PrEP-prescribing clinics. In her Washington Post piece, Wen describes how in Mississippi, some patients have to drive over 3 hours to get to the one health center in the area that prescribes PrEP.
Wen also points out that people need to ask for PrEP, or at least be honest about factors that may make them at-risk for contracting HIV. For folks living in ultra-conservative areas, the fear of being stigmatized, disrespected, and humiliated by a doctor may prevent them from asking.
To have honest discussions with a doctor, there needs to be trust. For a person without insurance – especially marginalized folks – they may not be seeing a doctor regularly, and may not have that relationship. We know from concrete data that the medical community provides substandard care to people of color and LGBTQ folks, making some distrust the entire system to the point where they don’t go to the doctor at all.
Until systemic changes are made, there will always be barriers to getting PrEP. If the White House is serious about “ending the HIV epidemic” then they should take a step back and try and address these access issues.
Stay sex positive xoxo