The Trump administration announced last week a brand new program that will provide HIV prevention medications without charge for uninsured patients. This pre-exposure prophylaxis (or PrEP) drugs are effective in preventing HIV, but with a cost of $2,000 a month, they’re far too expensive for people without insurance. This new program will provide PrEP at no cost for as much as 200,000 uninsured patients. Supporters have lauded this move being a significant step toward President Trump’s intention to end HIV in the United States. Others have criticized it as not going far enough: They would rather the govt expedite generic drug production and lower the price of PrEP. AD Both are missing an important point: Free or reduced-cost drugs may have no impact if patients can’t access them. The rural South is a growing epicenter for HIV, but as the South makes up about most new HIV diagnoses, it has a quarter of all PrEP-providing clinics. In West Virginia, only 27 percent of the state’s rural counties offer any HIV prevention services. In North Carolina, just two considering the state’s 85 local health departments reported to researchers last year they prescribed PrEP. In Mississippi, patients have taken to bring in three or more hours to access the one health center that dispenses 80 percent of all PrEP pills within the state. And that’s when the patient knows to question for PrEP. Only half of most uninsured patients have a regular supply of medical care.

Patients are at high risk of contracting HIV are by far less more likely to do so since they often possess by him marginalized communities that have deep distrust considering the medical system. A Centers for Disease Control and Prevention report found that while African Americans account for 44 percent of individuals who would be eligible for PrEP, they make up for only 11 percent among those on PrEP. African American men who have sex with men possess a 1-in-2 lifetime risk of contracting HIV, yet it includes only 26 percent on PrEP (in comparison with 42 percent of the white peers). Without concerted outreach efforts to these vulnerable communities, the promise of free drugs won’t translate to patients taking them.

The administration’s new program covers only medications themselves. The medical appointment to get the prescription isn’t covered, nor are lab tests or ongoing care. CDC guidelines require that patients undergo multiple blood tests before starting PrEP, and after that, regular testing every three months while on it. Regarding the uninsured, these tests cost hundreds of dollars a year and can price patients from PrEP care. Versus giving free medications to certain uninsured people, a more exceptional solution is helping these patients get health insurance. Medicaid already covers 42 percent of adults with HIV (in comparison with 13 percent of the general adult population), and patients on state Medicaid programs receive coverage not only for PrEP and HIV drug therapies but other comprehensive services such as lab testing, care coordination, and community-based services. Admittance to these public insurance programs is essential for prevention. The federal Ryan White program, which funds cities and states to care for low-income people with HIV, supports only those already diagnosed with HIV. It does not help individuals who could be prevented from getting HIV and does not cover PrEP. Expanding Medicaid to those at high risk for HIV would allow them to receive PrEP and insurance for it the other services they need. 

Patients also need more places to access HIV prevention and treatment. An integral access point is clinics funded by the Title X family planning program. Of the 4,000 Title X clinics throughout the country, 90% provide HIV testing, and a third offer PrEP. These clinics serve low-income patients in rural and underserved areas but now are threatened with closure because of Trump administration’s new Title X restrictions. When the Trump administration wants to achieve its aim of eradicating HIV, it is required to end harmful policies for example the Title X gag rule. And instead of dismantling the Affordable Care Act, it should support state-based Medicaid expansion. It is required to remove discriminatory policies for example the conscience rule and the public charge rule that further stigmatize LGBTQ, minority and immigrant populations that already face the best barriers to care. The Trump administration’s free medication program distracts from the real challenges of HIV prevention and treatment. Pills are no panacea when patients can’t access them in the first place, and after that can’t afford the rest of the health care which comes besides treatment. The administration has got the power to fulfill its promise to end the HIV/AIDS epidemic, but it must start with an honest study of its existing policies. Otherwise, it will keep making tiny steps forward against a backdrop of giant steps backward.

Author Resource Box:

A better way for the Trump administration to end HIV/AIDS. https://hagerstownairport.org/2019/12/09/a-better-way-for-the-trump-administration-to-end-hiv-aids/
Quality healthcare services offered for LGBT community in …. https://vietnamnews.vn/society/483418/quality-healthcare-services-offered-for-lgbt-community-in-hcm-city.html