For people who are HIV negative, a once-daily PrEP pill can prevent infection during sex with someone who is HIV positive no less than 99 percent of the time<\/a>. At the same time, most of the 1.2 million Americans<\/a> living with HIV follow an anti-retroviral therapy regimen that is so effective that it can make their HIV non-transmissible. These treatments are both a marvel of modern medicine and a living tribute to the more than 700,000 Americans<\/a> who have lost their lives to HIV since the first reported cases appeared in 1981.<\/p>\n Getting on PrEP, which was approved by the Food and Drug Administration in 2012, should be about as easy as getting on birth control, another daily pill prescribed for sexual health. In both cases, side effects are minimal and rare, and the costs are covered by most insurance plans.<\/p>\n But despite all that, PrEP remains exasperatingly out of reach for hundreds of thousands of people in the US who need it. Most Americans \u2014 about 60 percent<\/a> \u2014 don\u2019t know about PrEP in the first place. Even if they do know enough \u2014 and have the health coverage they need<\/a> \u2014 to ask a doctor about it, less than half of physicians<\/a> feel knowledgeable enough to prescribe PrEP, as Williams found. And other people still often struggle with stigma<\/a> from their communities and even from their health care providers<\/a>.<\/p>\n As a result, only about one-third of people<\/a> at risk of HIV in the US currently take PrEP. Worse yet, those who are the most likely to benefit from its protection are often the least likely to be on the medication. Among people at risk of HIV, Black and Latino bisexual and gay men, women, and Southerners consistently take PrEP at much lower levels<\/a> than the rest of the population, which may account for the troubling increase in new HIV infections<\/a> over the past decade in some areas in the US.<\/p>\n \u201dWe\u2019ve had a dramatic drop in new infections over the past 15 years, but we\u2019ve plateaued, and we\u2019ve plateaued among those same vulnerable populations,\u201d said Carl Baloney Jr., president of AIDSUnited. People like Brenton Williams can do everything right, he said, and yet, they still get lost in the cracks of this country\u2019s warped health system,<\/a> either because they lack health insurance, or because their providers don\u2019t know about PrEP well enough to prescribe it.<\/p>\n The gaps in PrEP coverage may soon get even wider, because the Trump administration has slashed hundreds of millions of dollars<\/a> in grants earmarked for PrEP outreach and HIV prevention. It is a maddening time to be an HIV advocate in the United States. After decades of getting to the point where an America free of HIV seemed in sight, the country feels on the verge of a tragic reversal. And the availability of PrEP is one of the most important factors in deciding what comes next.<\/p>\n \u201cThis is a disease that, with some strong policy support and political will, we could end in this country very quickly,\u201d Baloney Jr. said. \u201cThere\u2019s really no excuse for there to be new infections at any measurable rate in the United States of America.\u201d<\/p>\n \u201cAn awful lot of work for a disease you don\u2019t have\u201d<\/strong><\/p>\n Ironically, some of the challenges facing PrEP come from the incredible success of battling HIV. Almost everyone under the age of 35 is too young to remember a time before antiretrovirals, when HIV was a death sentence.<\/p>\n \u201cThe scope and the awareness of HIV really changed once more people were living with HIV than dying of HIV,\u201d Danielle Houston, executive director of the Southern AIDS Coalition, said. That is a massive achievement, she said, but one that has also \u201ccloaked the actual epidemic\u201d from public view.<\/p>\n \u201cThe scope and the awareness of HIV really changed once more people were living with HIV than dying of HIV.\u201d<\/p>\n \u2014 Danielle Houston, Southern AIDS Coalition<\/p>\n And though HIV has become much, much more treatable, it is still a widespread disease, more so in some communities than in others. In Washington, DC, for instance, nearly one in 50 residents<\/a> has HIV, among the highest rates in the country. Even with strict treatment regimens \u2014 which can cost upward of $1 million<\/a> over a patient\u2019s lifetime \u2014 people living with HIV suffer from higher risks of heart disease<\/a> and other comorbidities.<\/p>\n But the burden is not distributed equally, meaning that, in some communities, the actual HIV rate is much higher. At current rates, one in 15 white gay and bisexual men<\/a> nationally will be diagnosed with HIV in their lifetime. For Black gay and bisexual men, the likelihood rises to a startling one in three. For Latino gay and bisexual men, it is one in four. In DC, for example, the rate of HIV is starkly segregated, with new infections highly concentrated<\/a> in the city\u2019s predominantly Black neighborhoods.<\/p>\n And while more and more people are taking PrEP<\/a> each year, progress on reducing HIV rates overall has largely stalled and has even reversed in some communities \u2014 a trend that\u2019s tightly linked to PrEP usage rates. States with high levels of PrEP coverage<\/a>, like New York and Vermont, saw a 38 percent decrease in new HIV diagnoses between 2012 and 2022, while those with low PrEP coverage , like West Virginia and Wyoming, saw a 27 percent increase, according to a report by AIDSVu<\/a>.<\/p>\n Black Americans are by far the most likely to be impacted by HIV in this country, facing new infection rates at much higher levels today than have ever been reliably recorded among white Americans. In recent years, Latinos have faced an alarming increase in new infections, with rates rising nearly 20 percent<\/a> between 2018 and 2022.<\/p>\n And both communities of color<\/a> and women<\/a> take PrEP at low rates, relative to their risk of HIV. Black people account for nearly 40 percent of all new HIV diagnoses but make up only 16 percent of PrEP users, the majority of whom are white. One in five HIV infections occur in women, but they account for only one in 10 PrEP users.<\/p>\n Some of that may be due to the dangerously false perceptions<\/a> that women rarely get HIV and are therefore less likely to benefit from preventative services. Marnina Miller, Williams\u2019 fianc\u00e9e and co-executive director of the Positive Women\u2019s Network, a group advocating for people living with HIV, first tested positive for the virus in 2013, a time when PrEP existed but was poorly understood \u2014 stigmatized as a \u201cparty drug<\/a>\u201d on the grounds that it supposedly encouraged promiscuity and barely on the radar of most women. Even now, \u201cwomen are continuously an afterthought in the HIV epidemic,\u201d she said.<\/p>\n Black and Latino communities also have less access to PrEP as an extension of much broader, deeply entrenched healthcare disparities<\/a>. \u201cIt\u2019s not that women, Black, Hispanic, or Latinx individuals, or Southern individuals are being less responsible about their sexual health,\u201d said Houston. \u201cThey\u2019re more vulnerable to healthcare systems and policy changes\u201d that put treatment and preventative services like PrEP out of reach.<\/p>\n Insurance to cover the medication \u2014 which can cost up to $2,000 per month<\/a> out of pocket \u2014 is one barrier for many people. While there are options to get help paying for PrEP if people don\u2019t have insurance, like state-level PrEP programs<\/a> or patient assistance programs<\/a> offered by the drug manufacturers themselves, there\u2019s no preventative equivalent to the federally funded Ryan White HIV\/AIDS Program<\/a>, which supports people living with HIV who are uninsured or otherwise can\u2019t afford treatment.<\/p>\n Individuals also have to jump through hoops to make sure that not just the medication but also all of the other costs associated with PrEP \u2014 \u201cthe HIV testing, the labs, the doctors visits\u201d \u2014 are covered, said Jeremiah Johnson, executive director of the advocacy group PrEP4All.<\/p>\n And then, even if they do get a prescription, most Americans take PrEP in the form of a once-a-day-pill, with requirements to check in with their doctor every 3 months to renew their prescription. Not coincidentally, somewhere between 37 and 62 percent<\/a> stop taking PrEP within six months of starting.<\/p>\n \u201cThe thing that we\u2019ve heard repeatedly from PrEP users,\u201d Johnson told me, \u201cis that that\u2019s an awful lot of work for a disease that you don\u2019t have.\u201d<\/p>\n How to get more people on PrEP<\/strong><\/p>\n Navigating the PrEP landscape can be daunting in other ways, too, with critical information often arriving to people late, if it arrives at all. Only one of the two FDA-approved PrEP pills \u2014 Truvada \u2014 is legally approved for people assigned female at birth. Williams, who is a trans man, was unaware of this until I mentioned it during our call. \u201cI had no clue,\u201d he said. \u201cThis is the first time I\u2019m hearing this, but it\u2019s the kind of thing my doctor should have said to me.\u201d<\/p>\n Marnina Miller, co-executive director of the Positive Women\u2019s Network, and her fianc\u00e9 Brenton Williams. Courtesy of Marnina Miller<\/p>\n This pattern of unawareness about potentially life-changing treatments came up frequently in my conversations with advocates.<\/p>\n \u201dHearing about PrEP and what it could do to keep me HIV negative was transformative,\u201d said Baloney of AIDSUnited, of when he learned about the pill a decade ago. As a Black gay man, he said, \u201cthe first question I had was: How am I just hearing about this now?\u201d<\/p>\n The good news is, more people are hearing about PrEP now. Between 2023 and 2024, PrEP use increased by about 17 percent<\/a>. A huge part of that increase was the explosive growth in access via telemedicine driven mostly by MISTR<\/a>, a telehealth platform \u2014 and its femme spinoff, SISTR<\/a> \u2014 which now provides about one in five PrEP prescriptions<\/a> in the United States, according to a study by researchers at Emory University\u2019s Rollins School of Public Health.<\/p>\n Tristan Schukraft, an entrepreneur and self-professed \u201cCEO of everything gay\u201d who owns a luxury boutique hotel chain and a popular gay bar in West Hollywood, founded MISTR in 2018, because \u201ca lot of my friends were having challenges getting on PrEP,\u201d he told me. \u201cI realized that there has got to be a better way.\u201d<\/p>\n While some might assume that telehealth platforms skew toward \u201cwhite men or people with means,\u201d said Schukraft, almost half of MISTR\u2019s users are people of color<\/a>, higher than the average PrEP ratio, according to the Emory University study. More than three-quarters<\/a> of the platform\u2019s customers have never used PrEP before, and one-third are uninsured. (MISTR also helps uninsured patients navigate options for covering the cost.)<\/p>\n Getting on PrEP is hard if it\u2019s not available at \u201cplaces where people are already at, whether that\u2019s through telemedicine or a brick-and-mortar location that\u2019s truly accessible to them,\u201d said Johnson of PreP4All. He credited MISTR and initiatives like Iowa\u2019s state TelePrEP program<\/a> with actively \u201ctransforming PrEP access for people.\u201d<\/p>\n Many people still benefit from community-based outreach too.<\/p>\n Take Gail Prince, a grandmother who found out in 2024 that her partner of 30 years had knowingly infected her with an STI that he had been secretly taking medicine to treat. Almost immediately, \u201cI went down to the court building and filed the divorce papers,\u201d she said. \u201cI was like, \u2018No one else is going to protect me as I could.\u2019\u201d<\/p>\n Prince went to get tested for HIV at the Women\u2019s Collective, a clinic in DC that specializes in HIV-related services for women of color. She was negative. But after her husband\u2019s betrayal, \u201cI felt like I was nothing, dirty,\u201d she said. \u201cI didn\u2019t take care of myself.\u201d She stopped getting her hair done. But not for too long.<\/p>\n \u201cI knew that I had to actually think about myself in order to be here to see my grandkids graduate from high school and college,\u201d said Prince, who has since gotten back on the dating scene, now protected by PrEP, which she learned about at the Women\u2019s Collective. \u201cIt makes me feel better, because I know I\u2019m coming first. I\u2019m not waiting for a man who might not tell you anything.\u201d<\/p>\n She gets her PrEP through Women\u2019s Collective and also uses their food pantry and participates in some of their social groups, like their weekly \u201cCoffee House\u201d chats, further connecting her to the organization and its supports.<\/p>\n \u201cOrganizations like ours know that it\u2019s not just about HIV,\u201d Valerie Rochester, executive director of the Women\u2019s Collective, said. \u201cIt\u2019s about everything that is involved in a person\u2019s life\u201d that \u201ccould potentially prevent them from seeking medical care,\u201d like housing insecurity, a lack of social support, or substance misuse. \u201cWe\u2019re always looking to expand any ways that we can find to engage a client and keep them coming back.\u201d<\/p>\n Most people in the US take PrEP in the form of a daily pill, but injectables are becoming more common. Daniel Born\/The Times<\/p>\n Prince is one of the small fraction of people on PrEP<\/a> in the United States who get the medication through a shot every two months instead of a once daily pill. She started off on the pill Truvada, but like about half of PrEP users, \u201cit wasn\u2019t really working for me,\u201d she said. \u201cI was forgetting to take it.\u201d So when the Women\u2019s Collective introduced her to Apretude<\/a>, which is a once-every-two-month shot rather than a daily pill, she jumped at the chance.<\/p>\n Such injectable forms of PrEP \u2014 including the recently-approved Lenacapavir<\/a>, which requires jabs only once every six months \u2014 have the potential to radically increase the number of people protected from HIV. Over 80 percent<\/a> of people who go the injectables route are still on PrEP six months after they begin treatment, compared with about half who take the daily pill.<\/p>\n PrEP injections do have to be given in a clinic, which has led MISTR to set up \u2014 though not yet open \u2014 seven brick-and-mortar locations located in \u201cgayborhoods\u201d across the country. Patients will be able to visit them to get their biannual long-acting PrEP injections, which Schukraft called a \u201cgame changer\u201d \u2014 as long as people can afford it. MISTR is holding off on actually opening shop at those locations until more insurance companies begin covering the shots, which can otherwise cost almost $30,000<\/a> per patient per year.<\/p>\n Many states also now allow pharmacists, rather than just doctors, to prescribe PrEP<\/a>. And as injectables go mainstream, advocates are working to try to ensure more pharmacies are authorized<\/a> to administer them.<\/p>\n A country without HIV is now within reach \u2014 but at risk<\/strong><\/p>\n One day, getting on PrEP may be just as accessible, destigmatized, and routine as getting on birth control or obtaining other sexual health treatments. \u201cSay you go and grab your Plan B; there\u2019s PrEP right next to it,\u201d said Miller, of the Positive Women\u2019s Network, who hopes to see a world where \u201cprevention will be an everyday occurrence.\u201d<\/p>\n \u201cWe actually have the tools. We know how to eliminate HIV, and so, we can still turn this around.\u201d<\/p>\n \u2014 Vincent Guilamo-Ramos, Institute for Policy Studies at the Johns Hopkins School of Nursing<\/p>\n The country is not there yet, but it has been getting closer. Or, at least, it was before the Trump administration began gutting the Centers for Disease Control and Prevention\u2019s HIV prevention and treatment programs<\/a> and defunding local clinics<\/a> doing PrEP outreach work last year. While even red states have been shamed into maintaining funds<\/a> for HIV treatment in the wake of the Trump cuts, prevention programs remain threatened at a time when PrEP could be more accessible than ever.<\/p>\n In 2024, the Biden administration appointed Miller<\/a> as a member of the Presidential Advisory Council on HIV\/AIDS, which has been around since 1995. But Trump \u2014 who pledged to end the HIV epidemic in the US by 2030 during his State of the Union address<\/a> in 2019 \u2014 dismissed<\/a> the council last year alongside the entire staff<\/a> of the Office of Infectious Diseases and HIV Policy.<\/p>\n Vincent Guilamo-Ramos, director of the Institute for Policy Studies at the Johns Hopkins School of Nursing, is especially concerned about the impact of the Trump administration on Latino communities, who were already experiencing a largely hidden surge in HIV diagnoses in recent years.<\/p>\n The Trump administration\u2019s anti-immigrant rhetoric has likely made a growing problem even worse, he said. There\u2019s been \u201ca chilling effect for the entire Latino community\u201d when it comes to seeking medical care<\/a> or even gathering in public<\/a>, and that has extended to HIV prevention efforts. A few months ago, Guilamo-Ramos accompanied a mobile clinic that parked outside of a popular gay Latino nightclub to offer testing and treatment in downtown LA. Normally, he says, such \u201cbilingual and bicultural\u201d community outreach is the gold standard for getting more people on PrEP.<\/p>\n But, this time, he said, the club was empty. \u201cI said, \u2018Where is everybody? It\u2019s Friday night. People should be out,\u2019\u201d said Guilamo-Ramos. A clinic worker told him that people were \u201cafraid to come\u201d because of concerns about immigration raids.<\/p>\n It\u2019s been harder to continue to engage, to reach people through grassroots community efforts, he said, \u201cwhich is really the way to get to people who may have less experience with the health care system.\u201d<\/p>\n But like many other health care workers who\u2019ve fought to eradicate HIV, Guilamo-Ramos has seen enough to know that this is not the time to give up. In the early 1990s, his job was essentially palliative care for HIV-positive patients, helping \u201cpeople to make meaning out of whatever time they were fortunate to have left,\u201d he said. \u201cThat has changed dramatically.\u201d<\/p>\n \u201cDespite all these barriers,\u201d the fears, and the funding cuts, \u201cthe thing that is most hopeful, which keeps me going, is that we actually have the tools,\u201d he said. \u201cWe know how to eliminate HIV, and so, we can still turn this around.\u201d<\/p>\n For his part, Williams is still fighting to get on PrEP. He plans to take off work for his birthday this month and visit his doctor to advocate for a prescription once and for all. If that doesn\u2019t work, he\u2019ll turn to another clinic, he says \u2014 one that specializes in serving people like him.<\/p>\n The stakes are simply too high, and he has put too much time and effort into this already to give up. But it should never have been this hard. \u201cI still have to advocate every time I communicate with them\u201d about PrEP, he told me, which is outlandish, \u201cbecause this is something they themselves should be pushing\u201d more people to take.<\/p>\n \u201cI\u2019m trying to be patient,\u201d he said, but lately, that patience has been wearing thin.<\/p>\n You\u2019ve read 1 article in the last month<\/p>\n Here at Vox, we’re unwavering in our commitment to covering the issues that matter most to you \u2014 threats to democracy, immigration, reproductive rights, the environment, and the rising polarization across this country.<\/p>\n Our mission is to provide clear, accessible journalism that empowers you to stay informed and engaged in shaping our world. By becoming a Vox Member, you directly strengthen our ability to deliver in-depth, independent reporting that drives meaningful change.<\/p>\n We rely on readers like you \u2014 join us.<\/p>\n Swati Sharma<\/p>\n Vox Editor-in-Chief<\/p>\n","protected":false},"excerpt":{"rendered":"Brenton Williams finally felt he had the proper health insurance to ask his doctor about PrEP (pre-exposure prophylaxis),…\n","protected":false},"author":3,"featured_media":750226,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[30040,14268,210,1141,1142,881,67,132,68],"class_list":{"0":"post-750225","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-explainers","9":"tag-future-perfect","10":"tag-health","11":"tag-health-care","12":"tag-healthcare","13":"tag-public-health","14":"tag-united-states","15":"tag-unitedstates","16":"tag-us"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/116460675605116700","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/750225","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=750225"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/750225\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/750226"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=750225"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=750225"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=750225"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"A](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2026\/04\/Marnina-and-Brenton-1.jpg\"\/)
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