In his final State of the Union Address, President Obama told Congress, “Right now, we are on track to end the scourge of HIV/AIDS, and we have the capacity to accomplish the same thing with malaria — something I’ll be pushing this Congress to fund this year.” HIV experts applauded the President’s elevation of HIV/AIDS in the month preceding his annual budget request but had to wait to learn what exactly the President would propose to Congress. On February 9, 2016, President Obama released his Fiscal Year (FY) 2017 budget, proposing a record $4.1 trillion spending plan, including new funding for HIV prevention.
The FY 2017 budget provides $20 million for a new innovative pilot program to increase access to pre-exposure prophylaxis (PrEP) and allows health departments to use up to 30 percent of these available funds to pay for PrEP medication as the payer of last resort. I have previously written about the need for federal programs to provide financial assistance for PrEP. This pilot program is a significant step toward improving PrEP access in the United States.
PrEP, a pill taken daily to prevent HIV infection in people who do not have HIV, offers an unprecedented chance to end the HIV epidemic. When taken as prescribed, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by more than 90 percent. One concern that many advocates have is that PrEP may not be accessible to the most vulnerable and high-risk populations who may be particularly disenfranchised from getting PrEP because of its financial cost. A 30-day supply of Truvada, the only medication FDA-approved for PrEP, has a retail cost of approximately $1,160 with no insurance. Individuals with insurance can still have co-payments required by some insurance plans ranging as high as $1,300 per year. Without an expansion of financial assistance programs, many people who stand to benefit from PrEP cannot cover these costs.
Public programs, insurance programs, and other initiatives providing PrEP medication assistance are essential to reducing new HIV infections in the United States. Recent estimates of new HIV infections demonstrate that HIV continues to be a severe problem in the United States. Although new cases of HIV infection have dropped by 19 percent in the last decade due to declines among several populations, including heterosexuals, people who inject drugs, and African Americans, among whom African American women had the steepest decline, the statistics among gay and bisexual men and transgender women have not improved the same degree. New HIV infections significantly increased in the last decade among Black and Latino gay and bisexual men before leveling off in 2010. Young Black gay and bisexual men had the steepest increase in HIV diagnoses but have had a 2 percent decline since 2010.
The recent five-year trends coincide with the launch of the first National HIV/AIDS Strategy (NHAS) in 2010. The President’s budget offers promise for further progress through continued implementation of the NHAS, which was updated last year to guide the Nation’s efforts through 2020. This is an exciting time for the national response to HIV/AIDS, and investment in PrEP and other highly effective prevention approaches could accelerate progress toward the NHAS’s goals. Investment in PrEP is just one piece in a boarder budget that HIV experts will analyze more closely in the coming weeks. For now, it is important to recognize that expanding access to PrEP is key to ending the HIV epidemic in the United States.