Earlier this month, the United States helped deliver a major accomplishment in the global fight against HIV. The U.S. Food and Drug Administration approved a generic version of lenacapavir, allowing one of the world’s most effective injectable HIV prevention medications to reach approximately 120 low- and middle-income countries for about $40 per person annually. Such a low price gives more people access to the important drug, which can help better control the spread of HIV.
But there is an uncomfortable irony behind this achievement that can’t be ignored: While access to HIV prevention is expanding globally, funding cuts and policy changes in the U.S. threaten to make prevention harder to access for many Americans who need it most.
The U.S. is helping to create a global HIV prevention revolution, yet many Americans remain excluded from the same promise of access. According to HealthHIV’s State of HIV Prevention and Care Survey, 52% of PrEP users — individuals taking Pre-Exposure Prophylaxis for HIV prevention — reported delays or interruptions in their care because of insurance-related barriers.
The problem is even more pronounced among transgender and gender-diverse individuals, with 82% reporting delays or interruptions in PrEP-related care due to insurance processes. These findings expose a troubling reality: Even when highly effective HIV prevention tools exist, administrative barriers can keep them out of reach for the very communities most likely to benefit from them.
The survey also found that 76% of HIV providers reported funding disruptions that affected their ability to deliver services during the previous 12 months, while 23% reported eliminating injectable PrEP from their service offerings altogether.
We can’t champion expanded access abroad while allowing HIV prevention services, coverage, and care infrastructure in the U.S. to diminish. If we can help make lenacapavir affordable and accessible around the world, we should be equally committed to ensuring that Americans can obtain the prevention services, coverage, and support needed to benefit from it.
Dominic Calhoun is a public health statistician and advocacy journalist serving as Senior Program Manager of Advocacy at AIDS Healthcare Foundation
