As the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies is reviewing this week which programs to fund in the 2023 budget, many public health issues will require their attention. A funding decision that aims to end HIV—and that goal can be achieved—would also have long-term benefits for the entire health care system.
HIV continues to infect thousands of Americans every year many of them gay men, although an effective prevention tool called pre-exposure prophylaxis (PrEP) is available. PrEP, which reduces the risk of contracting HIV by 99%, was first approved by the FDA in 2012 in daily pill form and is now available in a superior form as injection every two months.
But most people who could benefit from PrEP don’t take it. US Centers for Disease Control and Prevention estimates only 25% of the 1.2 million Americans who could benefit from PrEP are prescribed it. Of those prescribed PrEP, the majority (65%) are white, while only 9% are black, 16% are Hispanic, and 10% are female.
The federal government and the US public health system have a responsibility to close these access gaps and disparities. This is why leaders in the HIV community have reunited to urge Congress to fund a new prevention program that takes the next step on the road to eliminating HIV.
There is no doubt that PrEP works when taken as directed, but there are many barriers to access. The most pernicious of these is stigma, especially in the South and among health care providers. There is also a lack of awareness. Blacks are half as likely to experience PrEP as whites, according to a study from the Johns Hopkins Bloomberg School of Public Health.
Past and current presidential administrations have committed to ending the HIV epidemic in the United States by 2030. Although there are programs to provide HIV care and medication to uninsured and low-income people living with HIV, the country does not yet have a national effort correspondent for PrEP.
President Biden’s budget included a 10-year period, $9.8 billion mandatory spending program to expand access to PrEP This proposal reflects the level of commitment needed. But since it will take time for the legislative process in Washington to get in place to consider such a large investment, Congress can provide immediate funding to the CDC for a PrEP grant program in the meantime.
The $400 million HIV community fundraising 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 health professionals. local health services. 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 alleviate stigma and awareness issues. 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 greatest health disparities in the country, particularly differences in new HIV diagnoses between whites and other groups – but also save the federal government money in the long run. There are approximately 35,000 new HIV diagnoses in the United States each year, and the lifetime cost of care for each new patient is approximately $500,000. By reducing new infections, the PrEP program would mitigate the financial impact of HIV on the US healthcare system.
Now is the right time for Congress to act. President Biden and many members of Congress have made funding a national PrEP program a priority. And every month of delay means many preventable HIV infections are occurring, disproportionately affecting vulnerable groups like low income and minority communities.
Given the highly effective prevention tools available today, with even longer-acting PrEP drugs on the horizon, it’s a shame that access to them is unnecessarily limited. The end of the HIV epidemic, which began 40 years ago, is truly in sight. New funding to promote and distribute PrEP is the next essential step in achieving this goal.
Carl Schmid is executive director of the HIV+Hepatitis Policy Institute, which promotes quality, affordable health care for people living with or at risk of contracting 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, that have or may have PrEP products now and in the future.