Breaking Down Barriers in Access to PrEP
Forty Years Into the HIV Epidemic, We Have the Tools to End It. Will We?
This year marks the 40th anniversary of the US Centers for Disease Control and Prevention’s June 5, 1981 report of five cases of pneumocystis pneumonia among gay men in Los Angeles. In words that are haunting with the knowledge of what soon followed, the report noted that the existence of pneumocystis pneumonia in previously healthy individuals was “unusual.” This correlation indicated that “[t]he fact that these patients were all homosexuals suggests an association between some aspect of a homosexual lifestyle or disease acquired.”
The LGBTQ+ community at that time existed in a world of invisibility, criminalization, and a harsh landscape devoid of any legal protections. In a world where people were getting sick and dying – sometimes within months of diagnosis, HIV stigma was fueled by the marginalization of the groups disproportionately affected by the epidemic, including gay men, people of color, people who inject drugs, and transgender people.
In the decades of crisis during the 1980s and 1990s, we could not have imagined the arrival of a simple, safe daily pill that reduces the risk of HIV transmission by close to 100 percent. HIV Pre-exposure Prophylaxis (PrEP) is a game-changer in HIV prevention. We have the tools to end the epidemic. Still, stigma and discrimination persist, and systemic inequities in our society and health care system resulting from homophobia, transphobia, and structural racism remain significant barriers. The CDC’s latest report indicates that only 23% of people for whom PrEP is indicated were prescribed it in 2019. But only 8% of Black people and 14% of Latinx people for whom PrEP was indicated were prescribed it in 2019 compared to 63% of white people.
Many factors contribute to the underutilization of PrEP, including racial and economic disparities in healthcare access generally and lack of access to information about the benefits of PrEP specifically. Stigma also continues to play a role. Fear of or experiencing anti-LGBTQ+ bias can dissuade people from asking their doctor for PrEP. And, despite PrEP having a straightforward protocol similar to other medications prescribed in primary care settings, we know too many physicians resist prescribing it even when asked by their patients. GLAD is using every legal tool at our disposal to stop anti-LGBTQ+ discrimination in healthcare. At the same time, we are working to expand all avenues for people to access this incredibly effective drug.
In June, Maine became a leader in the fight to end the HIV epidemic by passing An Act to Improve Access to HIV Prevention Medications (LD 1115). This new law, only the third of its kind in the country, authorizes pharmacists to dispense PrEP on a short-term basis. It is novel, bold, and will have multiple powerful impacts:
- Enabling the most vulnerable populations, including rural communities, to obtain PrEP quickly
- Removing cost barriers to PrEP consistent with federal directives
- Improving access to care by requiring pharmacists to link customers to medical care for ongoing PrEP oversight and other vital health needs
GLAD was proud to work with Equality Maine, the Health Equity Alliance, and the Frannie Peabody Center to pass this law. This win is crucial for Mainers, and we need more efforts like this across the country. That is why we are advocating for S.1407 in Massachusetts, a similar bill sponsored by Senator Julian Cyr currently pending in the 2021 legislative session.
GLAD has always fought for sound HIV prevention policies, often in the face of deep prejudices. Advocating for access to clean needles for people who inject drugs, education on sexual health and safer sex practices, consent-based HIV testing, medical privacy, and nondiscrimination protections for people living with or at risk for HIV have all been fixtures in our AIDS Law Project work. As science progresses and we now have the chance to end the epidemic in our lifetimes, GLAD is working to ensure barriers like racism and anti-LGBTQ+ stigma don’t get in the way of everyone having access to the prevention and care they need.