As the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies considers this week what programs to fund in the 2023 budget, many public health concerns will demand their attention. One funding decision that would aim to end HIV — and that goal can be achieved — would also provide long-term benefits for the entire health care system.
HIV continues to infect thousands of Americans each year, many of them gay men, even though an effective prevention tool known as pre-exposure prophylaxis (PrEP) is available. PrEP, which lowers the risk of contracting HIV by 99%, was first approved by the FDA in 2012 as a daily pill and is now available in a superior form as an every-other-month injection.
But most people who could benefit from PrEP aren’t taking it. The U.S. Centers for Disease Control and Prevention estimates that just 25% of the 1.2 million Americans who could benefit from PrEP receive prescriptions for it. Of those who have been prescribed PrEP, the majority (65%) are white, while only 9% are Black people, 16% are Hispanic, and 10% are women.
The federal government and the U.S. public health system have a responsibility to address these gaps and disparities in access. That’s why leaders of the HIV community have joined together to urge Congress to fund a new prevention program that takes the next step on the road to ending HIV.
There’s no question that PrEP works when taken as directed, but there are numerous barriers to access. The most pernicious of them is stigma, particularly in the South and among health care providers. There is also an awareness gap. Black people are less than half as likely to know about PrEP as white people, according to a study from the Johns Hopkins Bloomberg School of Public Health.
Both the past and current presidential administrations have committed to ending the HIV epidemic in the U.S. by 2030. While there are existing programs to provide HIV care and drugs for uninsured and low-income people living with HIV, the country does not yet have a corresponding national effort for PrEP.
President Biden’s budget included a 10-year, $9.8 billion mandatory spending program to expand access to PrEP This proposal reflects the necessary level of commitment. But because it will take time for the legislative process in Washington to work its way to consider such a large investment, Congress in the meantime can provide immediate funding to the CDC for a PrEP grant program.
The HIV community’s $400 million funding plan proposed to the House and Senate Appropriations Committees in early June would create a new national PrEP program within the CDC to distribute grants to clinics, community organizations, and local health departments. This funding would help these organizations cover PrEP and associated lab bills and adherence services, hire more providers, and expand education and outreach efforts to ameliorate stigma and awareness challenges. The CDC already has the authority to conduct this work; it just needs the funding to make it a reality.
The proposed program would not only help correct some of the largest health disparities in the nation — particularly the discrepancies in new HIV diagnoses between white and other groups — but also save the federal government money in the long run. There are about 35,000 new HIV diagnoses in the United States each year, and the lifetime cost of care for each new patient is about $500,000. By reducing new infections, the PrEP program would ease the financial impact of HIV on the U.S. health care system.
This is the right time for Congress to act. Both President Biden and many members of Congress have made funding a national PrEP program a priority. And every month of delay means that many avoidable HIV infections occur, which disproportionately impact vulnerable groups like low-income and minority communities.
Given the highly effective prevention tools available right now, with even longer-acting PrEP drugs on the horizon, it’s shameful that access to them is unnecessarily limited. The end of the HIV epidemic, which began 40 years ago, is truly within sight. New funding to promote and distribute PrEP is the next essential step for reaching that goal.
Carl Schmid is executive director of the HIV+Hepatitis Policy Institute, which promotes quality and affordable health care for people living with or at risk of HIV, hepatitis, or other serious and chronic health conditions. The HIV+Hepatitis Policy Institute receives funding from several pharmaceutical companies, including Gilead, Merck, and ViiV, which have or may have PrEP products now and in the future.