Wintertime was the worst, paranoia-wise. When Chicago temperatures dropped, Northwestern student David Guigis became hyper aware of every post-sex sneeze or cough. “Every time, you’re just thinking, ‘oh shit, I wonder if I have HIV,’” he says.
Guigis felt like he was gaining a measure of control over his own sexual and emotional life when, in 2017, he began taking PrEP, a pill that’s up to 99 percent effective at preventing HIV. But then his insurance started acting up, refusing to pay for mandatory check-ups because they were out-of-network. After racking up over $1,600 in medical costs, Guigis made the fraught decision to go off his meds (which are only effective when taken daily). “It’s just not financially feasible anymore,” he says. “It becomes this recurrent trauma because you can’t get the medication you desperately need.”
The piece of mind PrEP offers its users — as well as the tantalizing idea that the drug could end the HIV epidemic once and for all, making it a crucial piece in preventative plans rolled out by cities like New York and San Francisco — have made it a cause celebré among health policy officials. But seven years after the pill was approved by the FDA for preventative use, many would-be patients are still being forced to jump through unnecessary hoops to obtain access to the life-changing therapy.
Earlier this year, the Center for Disease Control and Prevention (CDC) reported that a majority of gay and bisexual men at risk of HIV in the U.S. were still not on PrEP, especially men of color who were at highest risk, even though nine out ten people surveyed were aware of the regimen. Out of the 1.1 million people who could benefit from PrEP, only 200,000 are currently taking it.
Last week, in a move that was applauded by AIDS activists, California became the first state in the country to allow pharmacists to dispense PrEP without a doctor’s prescription, thus removing one massive hurdle preventing the drug’s widespread adoption. Under the new law, which goes into effect in July of 2020, pharmacists who undertake special training will be able to provide 60 day supplies of the drug, on the spot, to patients who have tested negative for HIV in the previous seven days. (After their 60 day prescription is up, patients are required to obtain a prescription from a doctor.) The law also allows pharmacists to furnish PEP, a post-exposure prophylaxis meant to be used in an emergency after possible exposure to HIV.
But California faces a number of challenges in rolling out the landmark legislation. For one, the law can’t legally compel pharmacies to furnish PrEP to patients, and some pharmacists have already voiced their displeasure with the expansion in care. “Zero ways I’d dispense this without knowing renal function,” one pharmacist recently wrote on Reddit, noting the risk the drug poses to kidney function. “This is a terrible idea,” they added. Another warned that PrEP “isn’t a drug that people should take anytime they feel like it.”
The reluctance among pharmacists to prescribe PrEP could hamper efforts to expand the therapy across California, says Aaron Fox, director of governmental relations for the Los Angeles LGBT Center, a co-sponsor of the law. “If certain pharmacists are reluctant to provide the drug, it’s probably because they don’t think there are enough people in their communities that want it, which we know isn’t the case,” he says.
Fox is hoping that an educational campaign will drive queer people to demand that their pharmacists get trained. “There’s definitely a community advocacy component here,” he says. “We want people to go into their neighborhood pharmacies and ask about PrEP; ultimately, demand drives everything.”
He also hopes the legislation will spark broader awareness around the drug and get the public talking about issues related to access, as a growing chorus of politicians have already begun to do. In May, Representative Alexandria Ocasio Cortez confronted Gilead, the makers of PrEP, about the pill’s astronomical cost. “The list price is almost $2,000 in the United States. Why is it $8 in Australia?” the senator asked Gilead CEO Daniel O’Day before the House Committee on Oversight and Reform. “People are dying because of it, and there’s no enforceable reason for it.” (Gilead posted revenue of $3 billion off the once-a-day pill in 2018.)
