Cullen Smith takes an HIV preventative treatment day-after-day for “added safety” and “peace of thoughts” after he thought he could have contracted the illness from a companion final yr.
“As soon as that scenario got here up, if I needed to maintain my present well being, I wanted to take different actions,” mentioned Smith, an Atlanta resident. “I used to be high-quality, however that was greater than sufficient to make me determine to go for it, as a result of it’s only one much less factor to fret about.”
PrEP, or preexposure prophylaxis, is available in a each day oral tablet, which may cut back the chance of buying HIV via intercourse by about 99%, or by at the very least 74% in its injectable type. Smith mentioned he’s been taking the treatment for over a yr now and though the treatment has offered further safety, he mentioned that if the drug had been to get too costly, or not be coated by insurance coverage, he would take into account ending his prescription.
“I nonetheless should eat and pay hire. … If it obtained to some extent the place I needed to pay $1,000 a month, I’d should reevaluate some issues, and I’d in all probability come off of it,” Smith mentioned.
What Smith describes is a concern that many advocates in Georgia fear might turn into a actuality as the way forward for PrEP entry grows more and more unsure because of selections being made on the federal degree.
Earlier this month, the U.S. Preventive Companies Job Power — the U.S. advisory panel that determines which preventive well being measures, together with PrEP, insurers should cowl — postponed its third assembly in a row, deepening anxiousness amongst well being advocates and sufferers who depend on the life-saving drug.
PrEP is free underneath most insurance coverage, Medicare, and Medicaid, however with out protection it will probably value hundreds of {dollars} for brand-name choices.
In a state the place HIV charges are among the highest within the nation, and the place Black residents wrestle to entry PrEP in contrast with their white counterparts because of components like larger uninsured charges, advocates in Georgia fear that if the federal authorities chooses to finish insurance coverage protection for the treatment, Black of us will probably be hit hardest by the choice.
“Particularly in Georgia, Black communities are most disproportionately impacted by [HIV],” mentioned Justin Smith, the director of the Marketing campaign to Finish AIDS at Constructive Impression Well being Facilities, a company that gives complete care and preventive companies to these residing with or weak to HIV within the state. “I believe that if we see this potential discount in assets that go to HIV and to public well being, that the affect on Black communities could be even better.”
When requested for remark, a Well being and Human Companies spokesman mentioned in an announcement, “The primary [panel] assembly of this yr has been postponed and will probably be rescheduled within the coming months.”
Court docket resolution fails to cut back fears
A yr in the past, well being advocates had been much less nervous in regards to the Trump administration than about one other department of the federal authorities: the Supreme Court docket.
The excessive court docket had agreed to listen to a problem to the constitutionality of the Reasonably priced Care Act provision mandating protection of sure preventive companies, together with PrEP, by insurers for free of charge to sufferers. Two Christian-owned companies and a number of other Texas residents argued that the mandate should be struck down, sustaining that PrEP would “encourage and facilitate gay conduct.”
Moreover, they focused the construction of the Preventive Companies Job Power. When the panel assigns an A or a B advice to a preventive service — because it has for PrEP — the ACA mandates that insurers cowl it with no affected person cost-sharing.
For individuals who depend on PrEP, the stakes had been clear: If the court docket in any manner dominated in opposition to the mandate, the drug might turn into unaffordable virtually in a single day.
Black queer activist Preston Mitchum has been on PrEP since round 2014, two years after the drug was accredited by the U.S. Meals and Drug Administration. He remembers the obstacles many individuals confronted making an attempt to acquire it earlier than 2021, which was the yr non-public insurers had been required underneath the ACA to supply the drug for free of charge.
“It was exorbitantly costly once I first tried to entry it,” he mentioned in 2025, explaining that with out insurance coverage overlaying all or a part of it, the treatment might run about $2,000 a month.
“Nobody is ‘by accident’ on PrEP. It’s a constant routine that it’s a must to speak along with your medical supplier about,” he continued. “The truth that folks’s means to guard themselves could possibly be denied once we say that that’s what we wish them to do? That simply looks like a slap within the face.”
The court docket finally upheld the duty power’s constitutionality. However it additionally confirmed that the Well being and Human Companies secretary has the facility to nominate its members — and take away them at will. Given Well being Secretary Robert F. Kennedy Jr.’s previous actions, well being advocates say they aren’t assured that no-cost PrEP protection is safe. Final June, Kennedy, recognized for undermining established science, abruptly fired each member of a federal vaccine advisory panel, claiming that the transfer was essential to “re-establish public confidence.”
Fueling entry “in as some ways as attainable”
As uncertainty about the way forward for PrEP entry looms, state lawmakers and native organizations are working to extend the drug’s availability.
In Georgia, lawmakers are debating laws that may permit pharmacists to prescribe PrEP on to sufferers. Supporters say that the measure might make the drug simpler to acquire by permitting folks to bypass a health care provider’s appointment and begin remedy at native pharmacies.
“By doing this in pharmacies, it’s only a strategy to attempt to guarantee that extra folks may discover their strategy to this actually unbelievable prevention software,” mentioned Smith with Constructive Impression Well being Facilities.
Well being advocates say that increasing entry to PrEP is essential to addressing the racial disparities in HIV prevention, on condition that Black Georgians proceed to face excessive charges of recent HIV diagnoses however have decrease uptake of PrEP in contrast with different racial teams.
In keeping with the newest information from AIDSVu, a web-based HIV-tracking platform primarily based at Emory College, white residents in Georgia use PrEP at larger charges than Black residents; this sample displays nationwide disparities in PrEP use.
“If entry retracts, the people who find themselves already marginalized are going to really feel it much more,” mentioned Alphonso Mills, group engagement strategist for Constructive Impression Well being Facilities.
And as state lawmakers work to extend entry via coverage, on-the-ground organizations are working to get PrEP into the arms of residents in additional rapid methods.
For folks searching for PrEP with out insurance coverage, Mills mentioned that employees at Constructive Impression Well being Facilities work with pharmaceutical help applications and insurance coverage navigators to assist to cut back prices. However accessing the treatment doesn’t require a specialty clinic: Smith mentioned that folks also can acquire prescriptions via telehealth companies that ship drugs on to sufferers.
“The aim is basically to create a system the place there’s no incorrect door,” Smith mentioned. “We would like folks to have the ability to entry this unbelievable prevention software in as some ways as attainable.”
The nationwide telehealth platform MISTR affords PrEP via mail-order care throughout all 50 states, Washington, D.C., and Puerto Rico.
The corporate says that it already serves greater than 500,000 sufferers nationwide, and almost 1 in 3 folks utilizing PrEP within the U.S. receives the treatment via its service.
Information from MISTR means that telehealth could also be reaching populations that conventional well being care methods have struggled to have interaction with. About 18% of the platform’s sufferers are Black, 14% are girls, and 35% don’t determine as homosexual.
“Our final aim is to finish HIV transmission in the US. The science already exists. The instruments exist already. MISTR is right here to ensure the entry does too,” a spokesperson for MISTR mentioned.
Whereas the way forward for PrEP affordability stays unsure, well being advocates say that this isn’t stopping them from persevering with the combat to finish the HIV epidemic.
“That is actually a difficult time for all of us who’re working in public well being, however I believe that a part of the problem is ensuring that, throughout the political spectrum, we are able to guarantee that folks perceive that it is a situation that impacts folks throughout the board,” Smith mentioned.
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