Today, I review, link to, and excerpt from JN Learning‘s “Transcript PrEP Prevents HIV—If Patients Can Get It”.
All that follows is from the above resource.
TranscriptPrEP Prevents HIV—If Patients Can Get It[Automatically generated]Intro: From the JAMA Network, this is the JAMA Medical News Podcast, discussing timely topics in clinical medicine, biomedical sciences. Public Health and Health Policy featured in the Medical News section of JAMA.
Abbasi: On today’s show, we’re discussing the state of one of the most powerful tools in HIV prevention. pre-exposure prophylaxis, or PrEP, including how the landscape has changed in light of both scientific advances and access challenges I’m Jennifer Abbasi, Director of JAMA Medical News. Associate Managing Editor Kate Schweitzer is here to tell us about the news. Kate, thanks for joining. Thanks, Jen. So how transformative has PrEP really been in the goal to end the HIV epidemic?
Schweitzer: It’s hard to overstate. To the experts I spoke with, it’s one of the most important breakthroughs in medical history. When taken as prescribed, PrEP can reduce the risk of acquiring HIV by more than 99%. A bit of background, the first form of PrEP, a daily oral pill, was approved in the US in 2012. Since then, we’ve seen a rapid evolution in options. There’s now also long-acting injectable medications that can be given every two months or even every six months. There’s on-demand PrEP, and trials are testing a once-a-month pill. This menu of options is important. It gives patients choice and studies suggest that substantially increases uptake. And we’re already seeing that impact. PrEP use among eligible individuals has grown dramatically. By 2024, nearly 600,000 people in the U. S. were using it. At the same time, HIV diagnoses have been declining. Experts acknowledge that it’s difficult to attribute that trend to any single factor, but regions with higher PrEP coverage have seen the largest reductions in new infections. In states with the highest uptake, new infections drop by nearly forty percent. According to doctor Anna Person, an infectious disease physician at Vanderbilt University, we now have the tools we need to end this epidemic in the US.
TranscriptPrEP Prevents HIV—If Patients Can Get It[Automatically generated]Intro: From the JAMA Network, this is the JAMA Medical News Podcast, discussing timely topics in clinical medicine, biomedical sciences. Public Health and Health Policy featured in the Medical News section of JAMA.
Abbasi: On today’s show, we’re discussing the state of one of the most powerful tools in HIV prevention. pre-exposure prophylaxis, or PrEP, including how the landscape has changed in light of both scientific advances and access challenges I’m Jennifer Abbasi, Director of JAMA Medical News. Associate Managing Editor Kate Schweitzer is here to tell us about the news. Kate, thanks for joining. Thanks, Jen. So how transformative has PrEP really been in the goal to end the HIV epidemic?
Schweitzer: It’s hard to overstate. To the experts I spoke with, it’s one of the most important breakthroughs in medical history. When taken as prescribed, PrEP can reduce the risk of acquiring HIV by more than 99%. A bit of background, the first form of PrEP, a daily oral pill, was approved in the US in 2012. Since then, we’ve seen a rapid evolution in options. There’s now also long-acting injectable medications that can be given every two months or even every six months. There’s on-demand PrEP, and trials are testing a once-a-month pill. This menu of options is important. It gives patients choice and studies suggest that substantially increases uptake. And we’re already seeing that impact. PrEP use among eligible individuals has grown dramatically. By 2024, nearly 600,000 people in the U. S. were using it. At the same time, HIV diagnoses have been declining. Experts acknowledge that it’s difficult to attribute that trend to any single factor, but regions with higher PrEP coverage have seen the largest reductions in new infections. In states with the highest uptake, new infections drop by nearly forty percent. According to doctor Anna Person, an infectious disease physician at Vanderbilt University, we now have the tools we need to end this epidemic in the US.
Abbasi: It’s clearly transformative. So why then are there still tens of thousands of new infections every year?
Schweitzer: It truly comes down to access. Even though PrEP is so highly effective, it’s not reaching everyone who could benefit. About 1.2 million people in the U. S. are good candidates for PrEP, but only a third of them have a prescription. Inequity is a significant barrier. Communities with the highest rates of HIV Particularly black and Latino communities often have the lowest usage rates, and women, especially black women in the South, are also significantly underrepresented. Stigma is often cited as a reason for this. People in those populations may hesitate to visit clinics associated with HIV prevention, according to experts I spoke with. Of course, insurance coverage and cost play a significant role. Most insurance plans do cover PrEP, including Medicaid, which is the largest source of coverage for people with HIV. But in recent years, more than 25 million people have lost access to Medicaid, and 7. 5 million more people are projected to be cut from the program by 2034. To illustrate the impact, consider Lenicapavir, the latest PrEP injectable that received a standing ovation at a scientific conference when its astonishing 100% efficacy was announced. One dose of that twice annual shot costs more than $14,000. And even with insurance, ever-growing administrative hurdles like prior authorization and the impending increase in the frequency of Medicaid reenrollment to twice a year will likely delay treatment or interrupt care.
Abbasi: Your article also covered federal funding cuts. How did those factor in?
Schweitzer: Well, sweeping staffing cuts to the US Department of Health and Human Services have resulted in the loss of hundreds of roles, including some specializing in HIV prevention. And as a result of federal reductions in government-sponsored research, Dr. Person’s University made a $300 million budget cut, which forced her HIV clinic to lay off its entire team of nurse case managers She said this trickle-down effect is happening at clinics across the nation. And although Congress ultimately rejected a proposed $2 billion in federal cuts to HIV prevention programs in the fiscal 2026 budget, the threat of further cuts still looms. What seems to be most frustrating to those who work in HIV prevention is that these cuts come with very real consequences. Modeling studies suggest even a modest annual decline in PrEP coverage, we’re talking a 3% dip each year, could erase much of the progress in reducing HIV infections over a decade and cost us billions in additional lifetime health care costs. But there are bright spots. Some local health systems are experimenting with new ways to expand access such as allowing pharmacists to prescribe and administer PrEP and using telehealth for consultations. Ultimately, we have the tools we need to dramatically reduce HIV in this country The question is whether they will continue to get the support and funding they need to work.
Abbasi: Thanks, Kate. Alright, if you’d like to learn more, we’ll include a link to Kate’s story in the show description. This week we also published a story I wrote on why South Asian people in the US have higher risks for cardiovascular disease. You can find that and all of our stories at jamamedicalnews.com. Thanks to Kate Schweitzer for joining me. I’m Jennifer Abbasi for Jama Medical News. This episode was produced by Daniel Morrow at the JAMA Network. To follow this on other Jama Network podcasts, please visit us online at jamanetworkaudio.com. Thanks for listening and join us again next week.
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