The social determinants influencing PrEP use and access

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Karl Schmid: We have a lot to do. I don’t think we’ve done enough outreach and communication with the communities that need PrEP [pre-exposure prophylaxis] most, like black gay men and latinos. We still have a lot to do. I do not think these communities have been sufficiently reached. There is a lack of education, access to healthcare and sources of funding. When you have payers, there are always hurdles to overcome. PrEP is supposed to be free, with no co-payment if you have private insurance, but we still find many payers and private insurance companies charging out-of-pocket expenses for PrEP or for medical tests, doctor visits, or laboratory exams. This creates additional hurdles.

Access to health care is already difficult for certain population groups and even more so for others. Those extra barriers make it harder. Providers are the ones who need to prescribe PrEP and they don’t always talk about it with their patients. Especially in the South we still see a lot of stigma around HIV. And we didn’t have a concerted national campaign to go to the hardest hit communities. These are some of the reasons I feel these communities are not accessing PrEP the way they should.

There are a lot of things we can do to overcome the barriers to PrEP. One thing I would like to see is a national PrEP campaign, a national PrEP program that provides educational grants to the most affected communities. But we also need to grant providers and educate them on best practices on how to address these issues and how to prescribe PrEP and what is required. There are great CDCs [Centers for Disease Control and Prevention] Policies online and vendors can access them. We must also ensure that payers do not also implement barriers.

I would love to see a national PrEP grant program run out of the CDC to promote PrEP and provide grants to community health centers and the Ryan White Clinics to pay for medication and lab services, especially for people who don’t are insured, but it also helps the underinsured. [We need] To make people aware of PrEP, we need a national effort. These are some of the things I work on with others in the HIV community.

Lynne H Milgram, MD, MBA, CPE: Health equity is extremely important. Whenever we can address health inequalities, we should. We have done nothing in this area to address the potential health inequalities. When we rolled out the COVID-19 immunizations, we started looking at how we could do it and we used community resources in vulnerable areas. We did such a good job that these areas had higher vaccination rates than some of our areas where patients had to go to clinics.

It is possible to implement a strategy for your more vulnerable communities. An oral strategy is possible. Of course, you can drop off pills at the same places at the same time, whether it’s churches, schools, or community organizations. But this is where the long-acting injectables could be of value. Just as we treat patients with long-acting injections who suffer from mental disorders or behavioral disorders, it works better in community clinics or in any area where they can go into their communities without shame and without discomfort. But we haven’t done anything. Could we? yes we could It’s an area where long-acting injections would likely be very beneficial.

[The disparities and inequities] Start with the patient not having access to medical care. Although we don’t have that, we don’t have access to medical care or know where [to go]. There are free clinics, especially in this disease area, but people don’t know or have no education. Having that stigma and label is another factor. Lack of understanding, education and the feeling of being invincible are factors, and yet they are so vulnerable. It’s a lot of misinformation and maybe not even knowing where to go for treatment. That’s the biggest thing.

I have providers in vulnerable areas and they treat their populations. They come from their population. But there could still be areas where there is prejudice and patients are uncomfortable. They may not even speak the same language. There may be a language barrier or cultural barriers. Everything that exists in terms of racial differences and health inequalities exists in this disease state, and probably more.

Transcript edited for clarity.

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