HEALTH AND WELLNESS
HIV
I’ve been on PrEP for 11 years. Access to the HIV prevention drug is in danger
Michael Chancley
July 17, 2026, 8:02 a.m. ET
During a routine doctor’s visit in 2015, I approached my medical provider about prescribing preexposure prophylaxis, or PrEP, to me to reduce my risk of acquiring HIV. She had no idea what I was talking about. To my dismay and utter shock, my provider at the time had not even heard of the essential, mainstream pill to prevent HIV: Truvada, which was the only FDA-approved option for PrEP at that time
To her credit, and despite the lack of education on her part (and the incessant marketing campaigns geared to gay men), she did her due diligence to learn more about PrEP and called me in a few days later to take labs so that she could write the prescription. With insurance, the out-of-pocket cost was a $300 copay per 30-day supply of the once-a-day pill. As important as it was to me to reduce my risk of getting HIV with PrEP as a Black gay man living in the U.S. South, $300 per month was an impossible expense to incur. And it still is for far too many people seeking this kind of responsible and proactive healthcare.
Fortunately, I worked at a clinic that helped navigate patients through the process of getting PrEP. I learned about a manufacturer copay assistance program that covered the cost of the medication not addressed by my insurance provider. But I recognized my own privilege in that if I did not work at a sexual health clinic, I would not have known about the programs to assist with accessing PrEP and may not have known PrEP existed at all. As I learned while doing PrEP outreach for work, most community members were not aware PrEP existed either, and the few that did were not aware that programs existed to assist with the high costs associated with labs and medications.
More than a decade later, we now have multiple options for PrEP, including a low-cost generic daily pill and newer long-acting injectables. Today, choice exists and so does stigma-breaking visibility that just didn’t exist when I needed it most: PrEP is featured in major television and print campaigns, mentioned in popular culture, and widely promoted at events aimed at women and LGBTQ+ people
Even with all of these advances, several interconnecting barriers continue to hinder access and exacerbate disparities. The sexual health clinic where I access PrEP has been going back and forth with my insurance company for two weeks to get approval for a six-month injectable version of PrEP, which costs over $28,000 per year. For the last 11 years, PrEP has become an integral part of my sexual health routine, and I still encounter new challenges to consistent access
PrEP access challenges and disparities
Recent data released by AIDSVu highlight that despite increases in PrEP use, and with 644,000 people in the United States on PrEP, racial, gender and regional disparities continue to exist. In 2024, the South accounted for 39% of PrEP users, while making up 52% of new HIV diagnoses. Black people in the South account for 48% of new HIV diagnoses and only 23% of PrEP users, while Latino people in the West account for 51% of new HIV diagnoses and only 25% of PrEP users. Women and youth also continue to have high unmet needs for PrEP use.
Despite previous bipartisan commitments to end HIV as an epidemic by 2030 in the U.S., in 2026, we are seeing major threats to HIV prevention funding that impact HIV testing, education, outreach and PrEP. These proposed funding cuts coincide with cuts to Medicaid and expired ACA subsidies that are dramatically increasing the number of uninsured individuals and placing significant burdens on HIV programs across the country. Even prior to these challenges, most states in the South had not expanded Medicaid, a key factor as to why the region also has traditionally had disproportionate new HIV cases and poor PrEP utilization.
HIV prevention advocates fight back
In 2018, the team at PrEP4All, where I work full-time today, released a white paper calling for a federally-funded National PrEP Program to address cost barriers for uninsured and underinsured individuals, to create demand through community-led campaigns, and to expand provider education and access. That was the same year PrEP4All launched a National HIV Prevention Day to raise awareness of the fight for equitable access to comprehensive HIV prevention
For years, PrEP4All, activists, partner organizations and PrEP users have pushed for a National PrEP Program that would simultaneously eliminate the most common barriers to PrEP access, and that effort has gained support from leaders across the political spectrum. The first Trump administration even sued Gilead Sciences to enforce government-held PrEP patents after taxpayers invested $143 million in the underlying research. The Biden administration later proposed a $9.8 billion investment to expand access to PrEP, and in 2024, the CDC launched National PrEP Program pilot sites in five jurisdictions at the urging of PrEP4All and its supporters. Even during politically divided times, the country has continued to move closer to making a National PrEP Program a reality.
The facts are that federal HIV programs have more than 35 years of bipartisan support: In 2003, President George W. Bush created PEPFAR (the President’s Emergency Plan for AIDS Relief), which has saved 25 million lives worldwide. Domestically, Bush signed reauthorizations of the Ryan White CARE Act, expanding federal support for HIV care via a program that was first implemented during his father’s presidency in 1990. Protecting HIV funding has historically been a bipartisan commitment to public health and stability.
The road has become more complicated in recent years
As a long time PrEP user, a Black gay man in the South, a former patient navigator and a current HIV policy activist, I can personally and professionally attest to the urgent need for increased resources to access PrEP. Lack of health care coverage, lack of knowledgeable providers and lack of access to sexual healthcare facilities in rural areas are major drivers of PrEP access disparities impacting Black and Latino people, women and youth. Advocacy by PrEP4All and the Save HIV Funding Campaign has successfully averted $3.5 billion in HIV funding cuts, but preventing cuts is not enough. This National HIV Prevention Day, we continue to actively fight for increases in funding, maintenance of HIV prevention infrastructure, and a renewed bipartisan commitment from our leaders in government to establish a National PrEP Program and end new HIV transmissions once and for all.
Michael Chancley is a social worker, LGBTQ advocate, and communications expert based in Atlanta, GA. He has spent over a decade working directly with communities navigating complex healthcare systems and leading national and community-based campaigns to translate policy and public health issues into direct action. He is a HBCU graduate with a BA in Sociology and MSW, both from Southern University at New Orleans, and currently pursuing an MBA from Tulane University
About National HIV Prevention Day: Established by PrEP4All in 2018 and observed annually on July 17, National HIV Prevention Day is a national call to action to ensure equitable access to HIV prevention for all. Created alongside PrEP4All’s campaign for a federally funded National PrEP Program, the day advances the belief that HIV prevention is a human right and advocates for the investments and policies needed to end the HIV epidemic
