Pre-exposure prophylaxis (PrEP) is a pill that people can take daily that is up to 90 percent effective at preventing one from contracting HIV. But even though it is a key sexual health tool, many people who need the drug aren’t getting it.
The CDC recommends PrEP for a variety of groups. Men who have sex with men (MSM) are PrEP-eligible if they are HIV-negative, had more than two sex partners in the past twelve months, and had either an STI diagnosis or any condomless anal intercourse in the past 12 months. But so many of those men don’t have access to this medication to help prevent HIV.
A recent study found that one in eight PrEP-eligible MSM lived “PrEP deserts,” or at least a thirty minute drive from a clinic where they can access PrEP. The study used a database of publicly listed PrEP service providers to explore disparities in geographic access to the pill. The database illustrated that more than 100,000 MSM would need to travel more than sixty minutes roundtrip per PrEP care visit, and more than 38,000 would travel more than 120 minutes. MSM that live in rural areas and the South had longer commute times.
Upon reflection on days such as National Gay Men’s HIV/AIDS Awareness Day, which is September 27 every year, I realize how important it is for universities, health facilities, and other health venues in rural areas and the South to offer sexual health services like PrEP. This is crucial, as my university did not offer PrEP, and I would have had to drive up to ninety minutes round trip to a health center in nearby suburban city or an hour and thirty minutes one way, to a nearby metropolitan city.
The travel time it takes to acquire a pill like PrEP is a huge barrier, especially for Black and Latinx MSM in the South and rural areas. Many Black and Latinx MSM in these areas already face a variety of hindrances such as lack of comprehensive sex education, parental consent laws, fewer legal and policy protections, and stigma and discrimination in housing, healthcare, and work. Furthermore, the lack of Medicaid expansion in the South, particularly in rural areas, also leaves many MSM uninsured.
Where someone lives should not determine access to crucial sexual health services like PrEP. When data shows that there are eight times the number of PrEP deserts in the South than in the Northeast, we must all take action. PrEP should be made available in spaces beyond clinics and LGBTQ centers, and offered at pharmacies and on college campuses. Public health agencies must create new funding opportunities around PrEP access in cities and towns that have high rates of sexually transmitted diseases and exist outside of large metropolitan areas. Policy makers should support comprehensive sex education, expand and sustain access to Medicaid coverage across the country, fund HIV and AIDS education centers to train providers on PrEP and LGBTQ competency, and support mobile clinics and telehealth facilities.
Although the majority of PrEP service providers live in metropolitan cities, new advances in technology allow for more access to care. For example, TelePrEP was launched in Iowa to curb the HIV epidemic and address rural PrEP barriers. Telemedicine and distance-based care programs like TelePrEP offer medication delivery by mail and in-home visits via secure video conferencing with providers. The TelePrEP service was funded by the Iowa Department of Public Health and involved a public health partnership between a variety of groups, including pharmacists, physicians and public health professionals from universities, and local and state health department staff. If more programs like TelePrEP are launched, more people in rural areas and the South will have access to services like PrEP.
On this National Gay Men’s HIV/AIDS Awareness Day, remember that it is everyone’s role to ensure to folks have access to key sexual health services. It’s our duty to ensure that the most marginalized individuals are accessing the care that they deserve. Health care providers and policy makers must ensure that MSM living in the South and rural areas have access to PrEP without limitations.
Armonte Butler is a writer and activist based in Washington, D.C. He is passionate about adolescent sexual health and supports LGBTQ youth of color and youth living with HIV to become activists and leaders in their communities, on their campuses, and at the institutional, state, and federal levels. In addition, he has conducted an array of research on gender and sexual minorities in Argentina and the Dominican Republic. He holds Bachelor of Arts degrees in Global Studies and Gender Studies from Sewanee: The University of the South.