Over 100 community-based organizations, advocacy groups and health centers sent a letter this month to President Joe Biden urging him “to support the creation of a national PrEP grant program to prevent HIV in the United States.” The program, they say, will also help address related health disparities among Black Americans and Latinos.

PrEP, or pre-exposure prophylaxis, refers to daily pills or, in the case of one med, an injection that lasts two months. PrEP works really well at preventing HIV. In fact, scientists estimate PrEP to be about 99% effective at reducing the risk of acquiring HIV via sex.

The folks who signed the letter to the White House—including groups focused on HIV, hepatitis, LGBTQ issues and sexually transmitted infections (STIs)—spell out the challenges regarding PrEP:

PrEP is nearly 10 years old; however it is underutilized, particularly by the communities most impacted by HIV. Only 23 percent of the approximately 1.2 million people indicated for PrEP are receiving it. Expanding PrEP into minority communities is critical in addressing the ongoing disparities in PrEP access and uptake. In 2019, only 8 percent of Black/African Americans and 14 percent of Hispanic/Latino persons who were eligible for PrEP were prescribed it, compared to 63 percent of white persons.

 

Increasing access to PrEP requires dedicated funding and a program focused on increasing education to providers and those at risk of HIV and providing funding for ancillary services and the drugs for underinsured and uninsured individuals (especially in non–Medicaid expansion states). While the Ryan White HIV/AIDS Program is widely lauded for its care and treatment programs for people living with HIV, there does not exist a comprehensive nationwide program dedicated for the provision of PrEP for people who are at risk of HIV.

The letter asks the Biden-Harris administration to “include at least $400 million in [its] FY2023 budget to establish and fund a national PrEP grant program to increase awareness and access to PrEP and related services.”

The White House often releases the budget for the upcoming year on the first Monday of February, but Roll Call reports that the FY2023 budget will likely be delayed until after Biden’s State of the Union Address, scheduled for March 1.

Among the 111 organizations that signed the letter, those leading the call to action are HIV+Hepatitis Policy Institute, the Human Rights Campaign, NASTAD and The AIDS Institute.

Existing PrEP programs face a devastating loss of funding for HIV prevention. In fact, as of last month, HIV clinics and nonprofits serving those at highest risk for HIV—notably, Black, brown, queer and Southern communities—stand to lose over $100 million year. That’s because Gilead Sciences, which manufactures many blockbuster HIV and PrEP meds, is ending a reimbursement system, related to the 340B federal law on drug pricing, which helps fund the clinics.

Although health insurers must now cover PrEP, and generic versions are available—as is an injectable form of PrEP that lasts two months—many clinics rely on the 340B reimbursement system to remain open.

Although the first long-acting injectable PrEP—called Apretude (cabotegravir)— may work better than daily pills, a recent analysis suggests that it might not be cost effective. As STAT News reports:

Yet the convenience of a bimonthly shot might be overshadowed by the annual $22,200 cost. How so? By comparison, a generic version of an older PrEP pill known as Truvada costs $360. And based on cost-effectiveness calculations, Apretude would have to be priced at no more than $7,000, according to the analysis, which was published in the Annals of Internal Medicine.

The letter recently sent to the Biden-Harris administration joins other recent calls for a federal program to fund PrEP. As LGBTQ Nation reports, out gay Congressional Representatives Mondaire Jones (D–NY) and Ritchie Torres (D–NY) penned a letter signed by 56 other members of Congress and sent to the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services asking them to make the injectable PrEP Apretude available for free.

In addition, several members of Congress have introduced bills to make PrEP more affordable and accessible. For more about that, see “2021 Was a Year of HIV Progress; Now Let’s Focus on PrEP Access.”

PrEP is also a main element in the latest National HIV/AIDS Strategy, which was released on World AIDS Day. For details, read “What’s New in the Updated National HIV/AIDS Strategy?”