In the same week World AIDS Day was recognized, the Trump administration has unveiled a new program to provide free PrEP as part of the initiative to beat the epidemic by 2030.
Secretary of Health & Human Services Alex Azar announced the plan, known as “Ready, Set, PrEP,” in a conference call Tuesday with reporters, calling the initiative “a major step forward in the president’s plan to end the HIV epidemic in America.”
“We believe the president’s HIV initiative is and will come to be seen as one of the major health initiatives of the early 21st century,” Azar said. “The president’s HIV initiative is a huge opportunity to make an impact on Americans’ health and well-being. We have the tools to stop the spread of HIV in its tracks. Now it’s about execution.”
Among the details Azar enumerated was the number to call to enlist in “Ready, Set, PrEP,” 855-447-8410, and the website, GetYourPrEP.com.
To receive the free PrEP, Azar said an individual must have no prescription drug coverage, test negative for HIV and have a valid on-label prescription for PrEP.
Azar said HHS will cover the cost for the free PrEP through March 30 2020, but then private pharmaceutical retailers — CVS Health, Walgreens and RiteAid — will donate their pharmacy dispensing services to HHS and distribute the medication at its stores and via mail with no cost delivery.
“Although many programs already exist to expand PrEP access and affordability, our program is of a totally different scale,” Azar said. “It is a national comprehensive approach to free PrEP access to the uninsured, which differs from programs that focus on particular areas or on co-pays in particular.”
Asked about the cost, Azar said HHS is using a system through the pharmaceutical giant Gilead that costs the U.S. government about $200 per bottle and goes to the company, but avoids other costs such as retail and distribution.
The new free PrEP program, Azar said, is the implementation of the announcement earlier this year that Gilead would donate the medication to the U.S. government, which President Trump touted on his Twitter account. At the same time, HHS and Gilead are in the middle of litigation over a patent dispute over PrEP, but Azar said is unrelated to the free PrEP initiative.
“Ready, Set, PrEP” is part of the Trump administration’s plan to reduce the rate of new HIV infections by 90 percent by the year 2030. As part of that initiative, which Trump touted in his State of the Union address, the White House requested an additional $300 million in HIV funding for domestic programs, but at the same time made drastic cuts to global programs.
Azar said 57 target jurisdictions by the year’s end will have received HHS grants to design their implementation strategies, and four jurisdictions have already received funding to begin hiring and implementation: Atlanta, East Baton Rouge, Baltimore and the Cherokee Nation in Oklahoma.
However, Congress has yet to pass an appropriations bill to fund the U.S. government for fiscal year 2020, let alone this HIV/AIDS initiative in particular.
Azar said he hopes lawmakers will include that money as part of a continuing resolution or the upcoming budget for the Department of Health & Human Services, but failing that will seek funds from reprogramming through the White House Office of Management & Budget.
The free PrEP initiative comes the same day the Centers for Disease Control unveiled a new report finding only 18 percent of the estimated 1.2 million people at risk for contracting HIV, or about 219,700 people, are on the medication. Coverage, the CDC reports, is especially low among young people, black people and Latinos.
“The time is now to end HIV in America. We have the right tools, the right data and the right leadership to get this done,” CDC Director Robert Redfield said in a statement. “Those living with HIV are our best teachers. They are key to helping us reach people where they are so that we can better diagnose and link patients to care.”
The free PrEP initiative comes the same week as World AIDS Day. Unlike President Trump, who declined to mention LGBTQ people in his World AIDS Day proclamation, Azar enumerated in his statement “gay men and black Americans, Hispanic Americans, and American Indians and Alaska Natives” as among the groups predominately affected by the disease (although he still made no mention of transgender people).
As part of the free PrEP initiative, HHS created social media graphics for distribution. Among the images of the graphics is a gay male couple. Both of the individuals appear to be persons of color.
“We know that stigma is a common barrier to PrEP and we’ve made it a priority to end the stigma around PrEP and HIV,” Azar said. “‘Ready, Set, PrEP will help address stigma by making it more accessible, and raising rates of PrEP use, helping Americans take care of themselves and take control of their health.”
Azar unveils the free PrEP initiative as the Trump administration continues to make policies allowing health care practitioners to refuse treatment to patients based on religious objections, which critics say could allow for denial of care for people at risk of HIV.
In October at the Values Voter Summit hosted by the anti-LGBT Family Research Council, Azar touted the religious freedom initiative as a means to ensure all Americans are “free from discrimination” based on the “dictates of their conscience and the ways they live out their faith.”
Asked by the Washington Blade during the conference call whether it was disingenuous to promote both an HIV program and a religious freedom initiative allowing health practitioners to opt out of it, Azar dodged and instead was critical of the Obama administration.
“President Trump has grabbed on to this initiative and let this initiative to end the HIV epidemic America because we have the right tools, the right data and the right leadership,” Azar said. “The previous administration had the same tools, and the same data to be able to take this on, but what President Trump and this whole team are providing is the right leadership to say, ‘This is a commitment we’re making to end the HIV epidemic in the United States.”
HHS has created a Religious Freedom & Conscience Division to advocate for medical practitioners who object to providing services, such as abortion, gender reassignment surgery or HIV treatment, and instituted a “conscience rule” in regulation to allow these workers to opt out of those treatments. Three federal courts, however, have issued rulings barring the Trump administration from implementing the “conscience rule.”
Meanwhile, the Trump administration has rescinded one Obama-era regulation interpreting the ban on sex discrimination in health care under the Affordable Care Act to apply to transgender people, and another barring federal grantees from discriminating against LGBTQ people. Critics say that could hamper HIV treatment by enabling discrimination against communities most afflicted by the disease.
David Stacy, government affairs director for the Human Rights Campaign, said the Trump administration to trying to have it both ways with its anti-LGBT and PrEP initiatives.
“Increasing awareness of and access to PreP is an important step toward ending the HIV/AIDS epidemic — an epidemic that faces thousands of Americans, especially LGBTQ people and people of color,” Stacy said. “At the same time, the Trump-Pence administration has undermined efforts to end the epidemic by issuing new rules that empower health care providers to turn people away from lifesaving care simply because of who they are. Everyone should have access to medically necessary care, treatment and services and should never be turned away because of who they are or whom they love.”
