Pre-exposure prophylaxis

Now, the part I want you to sit with, an Emory group led by Aaron Sigler looked at U.S. pharmacy claims for the first six months after FDA approval, June through December 2025.

Out of roughly 573,000 PrEP users, about 7,100 were on lenacaprovir.

That's 1%.

Cabotegravir was 5.5%.

Oral PrEP was still 93%.

Early days, and the trend is upward, but looking at who is getting it, compared with white patients, black patients received about 17% as many lenacapivir prescriptions per new HIV diagnosis, and Hispanic patients about 19%.

Medicaid covered 28% of lenacapivir users versus 12% of oral PrEP users, and co-pays over $100 affected 5% of lenacapivir users compared with 1% on oral PrEP.

Read that together and the picture is clear.

Sometimes it happens in the context of intoxication.

And with the best will in the world, most people do not have perfectly protected sex every time they have a sexual encounter, particularly not when they're in their early 20s or have just moved perhaps to a metropolitan area and are enjoying exploring life so I would say that things happen that are not always perfect we now have better combination prevention approaches to HIV prevention so we have of course pre-exposure prophylaxis we know that being undetectable on treatment means you cannot sexually transmit your virus would my story have been different had I moved to London 25 years later when PrEP was available perhaps, I'm not sure.

But I would say that we cannot shame people for having sex, we cannot shame people for acquiring sexually transmitted infections, and that includes blood-borne viruses, despite our best attempts to offer better prevention technologies.

I absolutely agree that we can't.

And it was...

When I think about it, even that seems like a miracle.

And then when PrEP came along, was it for the first three years that PrEP was here? We were buying bits from India.

I remember Dean Street handing out a website where it was like a trusted website to buy it.

... take action.

Um, that might be, um, pre-exposure prophylaxis, so, um, PrEP, which for cisgendered men, um, can be taken as a daily dose-

Mm

... or as a on-demand dose.

...

Reach and, and PrEP, and so talk about that, about the process.

What was the process of, of, of Reach and how, and how that ...

First of all, what is Reach? Explain what that is.

And so when you walk into an established institution, you'll have legacy programs, the, "We've always funded this.

The President's budget has always funded this," and some where the president's budget has not funded.

So PrEP, for example, pre-exposure prophylaxis, which is something that was important for communities that were highly exposed to HIV, AIDS, and higher transmission rates, had not been funded in the budget for some time.

I happened to be good friends with the lead advocate at ONAP, or the head of ONAP, the Office of National AIDS, uh, Control Policy, uh, Doug Maxwell.

And since then, you've seen expanded HIV testing, increased access to treatment.

They've also rolled out just this year PrEP, which is the HIV prevention regime medication.

It's been legalized and rolled out here.

They've expanded peer outreach programs, condom distribution.

And since then, you've seen expanded HIV testing programs increased access to treatment.

They've also rolled out just this year PrEP, which is the HIV prevention regime medication.

It's been legalized and rolled out here.

They've expanded peer outreach programs, condom distribution.