The next stage of the Obama administration’s 10-year plan to treat and prevent HIV in the United States calls for “full access to pre-exposure prophylaxis services.” Both the Centers for Disease Control and Prevention and World Health Organization recently came out with recommendations for the widespread use of PrEP among certain at-risk groups, so a White House mandate could go far in promoting it.
But what exactly is meant by “full access?” Will the federal government start funding PrEP nationwide? Sources within the White House tell Plus the answer is categorically no. The administration has no plans to guarantee or in any way fund full access to PrEP, but officials do want to make access to the prevention strategy over the next five years a “clear priority” for both federal and local governments and organizations.
An administration official clarified that the president’s updated strategy is for PrEP to be made readily available to every patient fitting the guidelines issued by the CDC. Yet even in the clarification, officials were short on exactly how that would happen—and who would fund it.
“This call for full access to comprehensive PrEP services encompasses more than just access to the daily pill,” says the official, “but also includes important components such as access to regular medical visits—including HIV and STI screening—as well as wraparound services that help with treatment adherence.” Truvada, a drug also used in HIV treatment, is the only drug approved to date for use as PrEP.
The problems, say health advocates, are multiple. Many of those at risk for HIV complain they are not being offered PrEP by their medical providers, feel too stigmatized to request it, or are denied it even if they do. More important, the cost of PrEP can be prohibitive for those without insurance or whose insurers either don’t cover Truvada for PrEP or have extremely high co-pays.
Douglas M. Brooks, director of the Office of National AIDS Policy, says HIV “remains a major health crisis for the United States” and that President Obama’s HIV strategy for the next five years will continue what the administration has already done, not just at the federal level but nationwide, with state, local and private organizations. Among its goals: widespread PrEP access, earlier and more widespread HIV testing, expanded treatment in the hard-hit South, and viral suppression for those who are poz.
The cost? Obama has asked Congress for a $1.2 billion increase over last year’s budget, for a total of $25.3 billion in domestic HIV spending. How much of that will fund PrEP access, after Congress has signed off on the cash? No comment.