Column: Why is it so hard to get PrEP on campus?

Researchers at UNC recently contributed to a breakthrough that might have gotten us one step closer to eradicating HIV. Unfortunately, the director of the UNC HIV Cure Center, Dr. David Margolis, noted that we’re still pretty far from a pill that cures HIV. 

There is, however, a pill that can prevent HIV. 

Truvada is a once-daily pill that is taken as PrEP (pre-exposure prophylaxis), and can reduce the risk of getting sexually-transmitted HIV by 99%. Unfortunately, UNC students might have a hard time getting their hands on this life-saving medication on campus. 

As one of the leaders of anti-HIV research, you’d think that UNC would also be at the forefront of HIV prevention efforts, especially for its students. But I know from personal experience that some students face barriers to filling their Truvada prescriptions on campus.

Campus Health has amazing laboratory services for STI screenings and thoughtful, sensitive providers who can prescribe Truvada as PrEP. These resources are wonderful, and I’ve even come to form a great relationship with my provider about my sexual health, but the final step — actually getting Truvada on campus ⁠— is missing.

According to a pharmacist at Campus Health, it's possible for them to fill Truvada prescriptions. But for most insurance plans, including Student Blue, they can only fill it the first time before students have to find a specialty pharmacy off campus. For some students who are covered by Medicaid, they can forget about getting Truvada on campus at all.

This was my experience. 

I was on Medicaid insurance for my first three years at Carolina, which luckily covered Truvada for most of that time — and then I turned 21. Since North Carolina hasn’t expanded Medicaid under the ACA, on my 21st birthday, I aged out of comprehensive coverage. 

Fortunately, my family was able to get private insurance coverage about six months later. However, the next time I tried to get Truvada, the specialty pharmacy that I was referred to fumbled my case. Even after multiple rounds of phone calls with representatives, they couldn’t properly transfer my order to the nearest pharmacy. So, I gave up and opted not to take the medication.

Fortunately, I wasn’t at a super high risk of exposure to HIV at the time, and I was able to get better insurance coverage ⁠— but that’s a privileged position that not all students on this campus occupy.

Without insurance coverage, Truvada goes for $1,600 to $2,000 per month in the U.S.. So, ‘toughing it out’ and paying for it out of pocket isn’t a realistic option for anyone. And if you can’t reasonably get to an off-campus pharmacy, you might be out of luck.

Moreover, low-income, Black and Latinx folks are at the highest risk of contracting HIV. These same demographics are also the most likely to be dependent on Medicaid.

Let’s remember that there are low-income, Black and Latinx students on this campus. Let’s also remember that these students’ access to PrEP is being limited in a way that is antithetical to the groundbreaking strides that our University is making in HIV research. 

So, what can we do to make Truvada more readily available for students on campus? That’s a serious question, because HIV prevention is currently the best ‘cure’ out there, and our students shouldn't have to jump through hoops to stay safe and healthy.

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It would be an oversight not to acknowledge that there are folks in this area who don’t have the privilege of accessing UNC’s Campus Health resources. If you, or someone you know, needs more information, testing services or PrEP, here are a couple of resources for students and non-students alike who may be having a hard time getting medication: 

The Orange County Health Department Health Clinic offers free testing and counseling, and you might qualify for a month's supply of Truvada for $4.00. The Chapel Hill location is 2501 Homestead Road. 

In Durham, the Duke PrEP Clinic for HIV Prevention offers similar services, and payment plans are available for those who qualify. It is located at 40 Duke Medicine Cir, Clinic 1K, Room 5. 

opinion@dailytarheel.com