After years of advocating for HIV and AIDS treatment, Michael Chancley has come to a sobering realization - that a significant number of Black men could benefit from pre-exposure prophylaxis (PrEP) medication, but relatively few are taking it. PrEP, when used as prescribed, reduces a person's risk of acquiring HIV by about 99%. However, data from the US Centers for Disease Control and Prevention (CDC) reveals severe inequities when it comes to access to the medication.

According to the CDC, 1.2 million people were living with HIV in the US in 2021, with over half of new infections occurring among individuals residing in the South. Preliminary data from the CDC indicates an increase in PrEP prescriptions from 2019 to 2022, but there are persistent disparities. While 94% of White people eligible for PrEP have been prescribed the medication, only 13% of Black and 24% of Hispanic/Latino individuals have received it.

Despite Black Americans accounting for 42% of new HIV diagnoses in 2022, a mere 14% of PrEP users were Black, further highlighting the disparities. Dafina Ward, the executive director of the Southern AIDS Coalition, points to a lack of hospitals and medical providers, especially in rural areas, as a contributing factor to higher rates of the disease. Additionally, comprehensive sexual health education is lacking in many schools, exacerbating the problem.

Under the Affordable Care Act, PrEP is supposed to be free for almost all health insurance plans, and most Medicaid programs and insurance plans cover the medication. However, Chancley notes that a significant portion of the Black community remains uninsured, and lower incomes coupled with a lack of support from doctors hinder access to PrEP. In some cases, individuals in rural areas have had to travel several hours for PrEP because of a lack of local clinics or doctors who provide the medication.

Furthermore, the financial burden of ongoing lab work and consistent HIV and sexually transmitted infection screenings poses challenges for continued use of the medication. Even with insurance coverage, many people find that PrEP lab expenses are not adequately covered, forcing them to discontinue the medication or seek additional resources to cover the costs.

Chancley, who works as a communications and mobilization manager for PrEP4All - an organization advocating for improved PrEP access - notes that even as an advocate, he has faced obstacles with obtaining his prescription. A lack of culturally sensitive education, stigma, shame, and a lack of messaging specifically targeted at Black communities also contribute to the barriers.

In efforts to address these disparities, the Biden administration released a five-year strategy in December 2022 to end the HIV/AIDS epidemic by 2030. President Joe Biden has proposed a $9.8 billion National PrEP Program over a 10-year period to make the medication accessible to all Americans. However, systemic issues such as expanding insurance coverage and addressing healthcare deserts must be addressed before equitable access can be achieved.

Chancley and Ward agree that discussions about PrEP should be included in school curriculums on preventing sexually transmitted diseases and HIV, moving beyond a sole focus on condoms and abstinence. Ultimately, the goal remains to keep individuals safe and healthy by ensuring access to PrEP medication or providing appropriate HIV treatment and support services for those who test positive.

As the fight against HIV and AIDS continues, addressing the disparities and barriers that Black communities face in accessing PrEP medication is crucial to achieving a more equitable and healthier future.