Editorial: A national PrEP plan is needed

  • by BAR Editorial Board
  • Wednesday June 15, 2022
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People walk along pathways as they look at the AIDS Memorial Quilt in Golden Gate Park June 11. Photo: Cynthia Laird
People walk along pathways as they look at the AIDS Memorial Quilt in Golden Gate Park June 11. Photo: Cynthia Laird

The Federal AIDS Policy Project Coalition and Prep4All have sent a letter, signed by 100 organizations, urging the House and Senate appropriations committees to approve $400 million to fund a national PrEP program within the Centers for Disease Control and Prevention. While this is far short of the $9.8 billion over 10 years that President Joe Biden called for in the Fiscal Year 2023 budget, it's a meaningful start and something that HIV/AIDS advocates believe can be accomplished this year.

A markup in Congress is scheduled for June 23, and we urge the appropriations committees to approve this funding allocation.

Carl Schmid, executive director of the HIV and Hepatitis Policy Initiative in Washington, D.C., told us that a national PrEP program would lessen disparities among Black and Brown people that have been ongoing since the advent of PrEP nearly 10 years ago. As most readers know, PrEP, when taken as prescribed, is extremely effective in preventing HIV transmission. It's now available as both a daily oral pill as well as a longer-acting injectable. "Expanding PrEP use is essential in our nation's work to end the HIV epidemic," the letter states.

The funding would allow the CDC's Division of HIV Prevention to provide grants to health clinics and other centers for the purchase of medications, cover costs of labs, and fund essential support services such as counseling, linkage, and adherence service, the letter stated. Schmid said that funding to cover lab services and to ramp up participating doctors is critical in part because not all of the organizations are community health centers. There's another thing this funding would help address just by getting more people on PrEP: stigma.

"There's still so much stigma," Schmid explained, "especially in the South."

The topic of stigma was front and center at the moving exhibit of the AIDS Memorial Quilt in San Francisco's Golden Gate Park last weekend. As we reported this week, several speakers talked about the quilt as a valuable educational tool that helps reduce stigma by being able to talk openly about the disease and how it has affected people. Seeing the names of thousands of people who have died of the disease is a major reason the quilt exists — not only so that people won't be forgotten but also that others can become aware of the many HIV services and treatments that are now available despite the lack of a cure or vaccine. People across the country, whether they are LGBTQ, same-gender-loving, or straight allies, have all been affected by HIV/AIDS over the last 41 years. To reduce stigma, we must not be afraid to talk about the disease and we must encourage people to get tested and get on treatment if they test positive. For HIV-negative people, however, PrEP is a major breakthrough that can save many lives.

For the national PrEP plan, Schmid said the CDC is in the best position to swiftly provide the grants, particularly in underserved parts of the country. According to the Federal AIDS Policy Project Coalition and PrEP4All, it's estimated that only 25% of people who could benefit from PrEP have received a prescription. "PrEP use is highest among white people, at 66% of those who could benefit from receiving PrEP, yet only 9% of Black people and 16% of Hispanic/Latino people who could benefit from PrEP in the United States," the letter stated, referring to CDC data. Schmid said that a category of "other," at 9.3%, includes Native Americans and Asian Americans and Pacific Islanders. There isn't a breakdown for transgender people.

Schmid said the coalition has been pushing for a national PrEP program because there isn't anything on the prevention side like the federal Ryan White CARE Act that gives grants to various jurisdictions in the U.S. to provide services to people living with HIV/AIDS. "We came to the realization that we're not going to get $9.8 billion," Schmid said, pointing out that under the federal budgeting process known as mandating a similar cut to some other program will be required, which will not happen this year. "We've said that this year we all agreed on the appropriations proposal to go through the CDC," he added. Because this $400 million would be discretionary spending, there would not be cuts required under the mandating process.

Both the National HIV/AIDS Strategy and the federal Ending the HIV Epidemic Initiative rely on PrEP expansion as a key element for ending the HIV epidemic by 2030, as does San Francisco's Getting to Zero and similar programs in other cities.

Schmid praised Congressmember Barbara Lee (D-Oakland), who is one of the main proponents of the national PrEP plan the coalition is advocating for. Vice President Kamala Harris had carried a PrEP bill when she was the junior senator from California, Schmid said. Now, Senator Tina Smith (D-Minnesota) has taken it over, he said. House Speaker Nancy Pelosi (D-San Francisco), who has done so much for HIV/AIDS over her tenure, should get on board with this request.

We'd like to see the appropriations committees advance this $400 million funding request. It's long past time to develop a seamless process so that anyone who needs PrEP can easily get it.

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