As 2021 comes to a close, it is a good time to take a moment to reflect on the year and think about the challenges ahead. This year, we commemorated the 40th anniversary of the first cases of what would become known as AIDS, welcomed a budget proposal from President Biden that more than doubled the funding for the Ending the HIV Epidemic in the U.S. initiative and was fully supported by both the House and Senate. President Biden gave his full commitment to ending HIV during a White House World AIDS Day event and released an updated National HIV/AIDS Strategy for the U.S. 2022–2025. We in the HIV community have many reasons to be hopeful, and yet our work is far from done. We must come together as a community focused on ending the HIV epidemic in new and different ways.

Biden’s strategic plan continues a focus on ending the HIV epidemic by 2030 but also reflects several key Biden-Harris administration priorities, including an enhanced focus on addressing disparities and health inequities. For the first time, the strategy recognizes racism as a serious public health threat that drives and affects HIV outcomes. The strategy also details the critical role the Affordable Care Act plays in increasing access to HIV prevention and care services, places a greater emphasis on addressing the syndemics related to HIV including viral hepatitis and sexually transmitted infections (STIs), and reinforces the need to focus on structural determinants of health such as behavioral health and access to housing.

The strategy also calls for a renewed whole-of-society effort. During its development, several government departments or agencies joined for the first time or expanded their participation. The strategy also includes a call for the private sector to be involved in our nation’s effort to end HIV. The updated strategy, just like the current one, is expected to run through 2025 and set a goal of reducing HIV by 75 percent by then.

Also included in the strategy is a focus on increasing access and sustained use of PrEP, or pre-exposure prophylaxis. PrEP is nearly 10 years old, and while we have seen recent gains in the number of people taking it, we have considerable work to do. Only 23 percent of the approximately 1.2 million people indicated for PrEP are receiving it. Expanding PrEP into minority communities is critical in addressing the ongoing disparities we see in PrEP access and uptake. In 2019, only 8 percent of Black/African Americans and 14 percent of Hispanic/Latino persons who were eligible for PrEP were prescribed it, compared to 63 percent of white persons.

While the Ryan White HIV/AIDS Program is widely lauded for its care and treatment programs for people living with HIV, there does not exist a comprehensive nationwide program dedicated for the provision of PrEP for people who are at risk of HIV. In the months and years ahead, new long-acting forms of PrEP are expected to be brought to market—in fact, the FDA approved the first long-acting injectable PrEP this week. Now is the time to invest in this key intervention to help bring about the end of HIV in the United States.

Several members of Congress are focused on increasing access to PrEP, and two critical pieces of legislation have been introduced recently. The PrEP Assistance Program Act (HR 5605), introduced by Representative Bonnie Watson Coleman, along with her colleagues Representatives Barbara Lee, Adam Schiff and Mondaire Jones, would help fill that void by providing $400 million annually to states, community-based organizations, community health centers, and others to establish and support PrEP programs. These programs would provide not only PrEP and associated medical services, but also the community and provider outreach needed to carry out successful PrEP programs. The bill currently has 40 cosponsors and has been referred to the Energy and Commerce Committee.

Additionally, on World AIDS Day, Senators Tina Smith, Representative Adam Schiff and colleagues introduced the PrEP Access and Coverage Act, an update of a bill previously authored by Vice President Kamala Harris when she was in the Senate. Like the Watson Coleman bill, it would establish grant programs to pay for PrEP and its ancillary services and separate grant programs for public and provider outreach. It would also ensure comprehensive coverage and eliminate out-of-pocket costs for PrEP for individuals who have private insurance, Medicare, and Medicaid.

It is critical that we invest in addressing barriers that impede access to PrEP for people in the U.S. by designing and funding a national PrEP program focusing on increasing education to providers and those at risk of HIV and providing funding for ancillary services and the drugs for uninsured individuals (especially in non-Medicaid expansion states).

This past year has shown us that the HIV community is creative, dedicated and resilient. However, it has also shown us that investing in our HIV infrastructure is key to reaching people where they are and being able to design innovative services to increase access.

We must invest in PrEP in a similar way to how the community came together to enact and fund the Ryan White CARE Act in 1990. It is critical to address racial and ethnic disparities that continue to exist in new HIV diagnoses, and we cannot expect to end the HIV epidemic by 2030 without addressing this gap in services. 

Carl Schmid is executive director of the HIV+Hepatitis Policy Institute, which promotes quality and affordable health care for people living with or at risk of HIV, hepatitis or other serious and chronic health conditions. Follow the HIV+Hepatitis Policy Institute on Twitter: @HIVHep