“Black Americans still struggle to access PrEP”
World AIDS Day just passed on December 1, accompanied by the predictable onslaught of articles hand-wringing about how just not enough people are taking PrEP, darn it. This will be a short post, but I remain committed to keeping you up to date on the state of PrEP propaganda in the U.S., so here we go.
We open with the heartrending personal story, with some propaganda sprinkled in:
After nearly a decade of working as an advocate for HIV and AIDS treatment, Michael Chancley said he came to a sobering realization.
“Seeing that people who look like me, who hang out at the same places as me, who were testing positive or in HIV care made me realize like, ‘Oh, you could be vulnerable to acquiring HIV as well,’” he said.
So, the 38-year-old said, he started using PrEP, which stands for pre-exposure prophylaxis, a medication that decreases a person’s risk of getting HIV from sex or injection drug use by about 99% when used as prescribed, according to the US Centers for Disease Control and Prevention. The medication can be taken via pill or shot.
Most of this article is the predictable dismay over the fact that the African American community is simply not taking advantage of PrEP.
Thousands of Black men could benefit from the medication, but relatively few are taking it.
About 1.2million people in the US were living with HIV in 2021, the most recent year for which data is available, according to the CDC. More than 52% of new HIV infections that year were among people who lived in the South.
According to preliminary data released by the CDC in October, there was an increase in PrEP prescriptions from 2019 to 2022, but “severe and widening inequities persist.” The CDC also noted that according to estimates, “94% of White people who could benefit from PrEP have been prescribed it, but only 13% of Black and 24% of Hispanic/Latino people who could benefit” have been prescribed the drug.
Yet again, we see that the number of HIV-positive Americans has stubbornly refused to budge from 1.2 million—0.3% of the population—in forty years, baffling behavior for an infectious sexually transmitted pathogen.
They spend a fair amount of words on the financial barriers to PrEP access.
Under the Affordable Care Act, also known as Obamacare, PrEP “must be free under almost all health insurance plans,” according to the CDC. The agency also noted that most Medicaid programs and insurance plans cover the medication.
But Chancley said that many in the Black community remain uninsured and that lower incomes and a lack of support from doctors can also prevent those who need the drug the most from gaining access.
Chancley said he has seen people who live in rural areas travel 2 to 3 hours away for PrEP because they do not have clinics or doctors near them who provide PrEP.
What’s more, lab work and consistent HIV and STI screenings are required for continued use of the medication, which can also become a financial burden.
“A lot of people have reached out to us because even with insurance coverage, PrEP lab should be covered, we’re seeing that insurance companies have not been compliant,” he said. “So, often people have to discontinue PrEP or find the resources to cover labs and provider visits.”
It will never cease to amaze me the push to get people onto PrEP, which curiously happens to require regular lab work and doctor visits to make sure they “stay negative,” effectively retaining them in care for a condition they don’t even have. Amazing.
There is only one other totem of note and it is the following:
In December 2022, the Biden administration released a five-year strategy to end the HIV/AIDS epidemic by 2030. President Joe Biden also proposed a 10-year $9.8 billion National PrEP Program that would make the medication available to all Americans.
I’m going to be very interested to see how this plays out in the next six years. Given that the prevalence of HIV positivity has been completely flat for forty years, I’m skeptical as to whether we’re going to drop to zero by 2030. I guess we have to just wait and see.
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You know it dawns on me one of the reasons for the low uptake in the Black community may have something to do with not identifying with having had a direct AIDS crisis. Tangentially yes through some Black gay men, but as a community at large. Gay men even now have this defining thing in AIDS, regardless of what it was from our standpoint, there was something going on traumatic and that creates a kind of identity and emotional bond to that history. It's why so many will subject themselves to potentially liver and kidney ruining medications for long periods of time and without question, because taking PrEP links us to that emotional history.
The Black community I don't think has that with AIDS. They were never defined as a specific 'risk group' despite having a larger representation in being 'HIV positive', it was gay men who were the brunt of AIDS sufferers (whatever it actually was).
Despite what we're told about Africa being hard hit by AIDS (despite not looking like American Gay AIDS, Duesberg really spells this out), American Black folks I'm guessing don't resonate with African AIDS in the same way as gay men now resonate with AIDS from the 80s.
So the long arc on this is that the Black community don't see PrEP as this 'thing' they need to embrace.
This just guesswork on my part, I could be wrong. But it's something that occurred to me.
Hmmm