“I don’t prescribe those kinds of medicines” the older, White, gray-haired physician said in his judgmental southern drawl. I am sitting in this exam room at the public health department in Mobile, Alabama with a mix of emotions. I am grateful for the partner that thought enough of me after our encounter to provide my contact information so that I may receive STI testing. Despite feeling relieved from the negative STI test results, I was angered by the explicit bias and dismissiveness and judgment of this physician, his attitude reinforcing the stigma of sex and HIV that is so pervasive in society.
First I thought “What do you mean? Do you want me to remain vulnerable to getting HIV?,” and secondly “How are you, as a physician working at a free clinic in a public health department, not familiar or comfortable with PrEP?” At the least, this physician should have provided a referral to someone with more experience with PrEP. His egregious lack of concern and compassion were alarming. His lack of cultural competence was disheartening. No one should ever experience this. As a Black, openly gay physician, this negative experience motivated me to pursue my own clinical interest in HIV prevention and to advocate for a national PrEP program, which would help eliminate existing barriers to access, that in turn are creating health disparities among Black and Brown communities.
In March of 2022, President Biden proposed the creation of a new national PrEP program that would provide access to PrEP for underinsured and uninsured people (https://www.usnews.com/news/health-news/articles/2022-12-01/on-world-aids-day-white-house-announces-plan-to-end-epidemic-by-2030). Pre-Exposure Prophylaxis (PrEP) is medication taken to prevent HIV through sex and needle-sharing. It has been available as a daily pill since 2012, and more recently became available as a long-acting injectable medication that can be taken once every two months. PrEP is highly effective at preventing HIV, reducing the chance of contracting HIV by 99% when taken as prescribed.
Communities of color continue to be disproportionately affected by HIV. Black people account for roughly 13% of the US population, and yet they represented 42% of all new HIV diagnoses in 2020; Latinos make up roughly 19% of the US population, and represented 27% of all new HIV diagnoses in 2020. According to the CDC, there were 30,635 people ages 13 and older who were diagnosed with HIV in 2020. Among those HIV diagnoses, 71% of new cases were among men who have sex with other men, of which 39% were among Black men and 31% were among Latinx men. Transgender women made up 2% of new HIV diagnoses, while transgender men made up of < 1% of new HIV diagnoses (https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics). 22% of new HIV diagnoses in 2020 were among heterosexual people, which highlights that HIV impacts everyone, not just the LGBTQ+ community.
Yet there remain many obstacles to receiving equal AND equitable access to HIV prevention such as stigma and bias towards sex and STIs (Sexually Transmitted Infections) among patients and healthcare providers, lack of comprehensive, gender affirming sex education both in schools and in medical training, navigating a complex healthcare system, and paying for PrEP. For those who are underinsured or uninsured, there are 14 states that have PrEP assistance programs listed (https://nastad.org/prepcost-resources/prep-assistance-programs may access the following programs).
In addition, there are other programs such as
ViiV Healthcare’s program to help pay for the long-acting injectable PrEP (https://www.viivconnect.com/).
“Ready, Set, PrEP,” a national program that provides access to PrEP medications (https://readysetprep.hiv.gov/)
Gilead’s co-pay assistance program (https://www.gileadadvancingaccess.com/)
PrEP Locator, which is a national directory of healthcare providers who prescribe PrEP (https://preplocator.org/)
As an adolescent medicine physician, I provide comprehensive gender affirming sex education and I am the doctor that prescribes “those kinds of medicines”. I believe that PrEP should be made available for all - at no cost.