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CDC sees inconsistent gains in HIV prevention prescriptions

Despite funding to expand access to HIV prevention drugs, gains in prescriptions have been largely limited to white individuals

Members of the New York City AIDS Housing Network attend a rally with AIDS activists to urge Congress to reauthorize a fully funded global AIDS measure to provide comprehensive prevention, treatment and health care.
Members of the New York City AIDS Housing Network attend a rally with AIDS activists to urge Congress to reauthorize a fully funded global AIDS measure to provide comprehensive prevention, treatment and health care. (CQ Roll Call file photo)

The Centers for Disease Control and Prevention published preliminary data Tuesday showing that more than one-third of individuals eligible for a commonly used HIV prevention drug received a prescription, as funding for a critical HIV program grew 16-fold between fiscal years 2019-2023.

But the reach of this strategy is highly inconsistent among racial groups.

Pre-exposure prophylaxis, or PrEP, is a drug used to reduce transmission of HIV after exposure, and is recommended for individuals at high risk of contracting HIV.

The federal government has taken numerous steps to increase access to PrEP and reduce the spread of HIV, distributing the drug through multiple government programs. It’s also covered as a free preventative service through most health plans through the 2010 health law.

But CDC data released Tuesday showed that despite increased investments in expanding access to PrEP, gains in prescriptions have been largely limited to white individuals.

In 2022, 36 percent of eligible individuals received a PrEP prescription, up from 23 percent in 2019 — the year that the Trump administration launched the “Ending the HIV Epidemic in the U.S.” program. That program aims to reduce 75 percent of new HIV infections by 2025 and 90 percent by 2030 through increased testing, treatment and PrEP usage.

While all racial and ethnic groups showed some gains in prescriptions, the changes among Black and Hispanic/Latino individuals were minor, according to the report.

The percentage of eligible white individuals who were prescribed PrEP grew from 60 percent in 2019 to 94 percent in 22. Among Hispanic/Latino individuals that number only grew from 15 percent to 24 percent, and in Black individuals it grew from 8 percent to 13 percent.

Prescriptions among eligible women also lagged their male counterparts, at 15 percent compared to more than 40 percent in 2022.

“Deeply entrenched social determinants of health cause and exacerbate many of these disparities and their outcomes,” the CDC report reads. “These data highlight the importance of focusing programs and policies to accelerate progress in prevention and treatment for disproportionately affected groups, particularly Black and Hispanic/Latino men and women.”

The “Ending the HIV Epidemic in the U.S.” program launched during fiscal 2019 using $35 million of preexisting HIV funds. Congress appropriated $267 million for the program in fiscal 2020 and more recently $573 million for fiscal 2023.

The CDC report states that prevention resources for the program have not met rising needs or the president’s budget request for the program. The White House requested $850 million for the program in fiscal years 2023 and 2024.

“Continued and expanded efforts will be vital to overcome the significant barriers that continue to hinder PrEP uptake, including lack of knowledge and lack of trusted or easily accessible PrEP providers in many communities,” the report states. “This will require increased investments in community outreach, education, and services, as well as efforts to address the root causes and social determinants that contribute to HIV disparities.”

Funds for the program for fiscal 2024 remain in flux until Congress reaches an appropriations deal. 

The Senate’s marked up Labor-HHS-Education bill would increase its funding to $616 million, while the House version, which has not yet been approved by the full Appropriations Committee, would eliminate funding for the program under CDC and the Health Resources and Services Administration.

“While the data demonstrate progress in PrEP usage, which will translate into fewer new HIV transmissions, the low usage of PrEP among the communities most impacted by HIV points to the need for increased and targeted federal resources,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, who added he also worries cuts to the program’s funding will increase HIV transmission and long-term costs.

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