To the Editor,
In “Why is it so hard to get PrEP on campus?” Devon Johnson outlines the disturbing challenges he faces in trying to get and stay on PrEP to prevent HIV infection. Mr. Johnson rightly paints a picture of a complex healthcare system that prioritizes treatment over prevention and that erects barriers to access to care. At the same time, he highlights potential and actual efforts to overcome these obstacles to get PrEP to people who can benefit from it.
In the absence of universal health care, universal health insurance should be a national priority. However, our state legislature, like most every state in the South, obstinately refuses to expand Medicaid, even though doing so would bring health care coverage — including PrEP — to half a million North Carolinians. Soon, states that have expanded Medicaid, may be in the same boat as attacks have battered the Affordable Care Act and its fate has been left in the hands with an expected Supreme Court case to be heard later this year.
At Carolina, Campus Health has been at the forefront of adopting PrEP and, as Mr. Johnson writes, the providers there have been “amazing” in taking a sex-positive approach to STI prevention. Such access to sensitive and knowledgeable clinicians cannot be taken for granted, as arguably the greatest obstacle to PrEP use in the U.S. is a failure among healthcare providers to assess candidacy for PrEP and then prescribe it. Yet, Campus Health cannot insulate students from our flawed healthcare system and serious problems like threadbare insurance policies, pharmacy glitches, prior authorizations and onerous paperwork. Only serious healthcare reform can tackle these impediments to care but the prospects for that are, at best, very dim.
Fortunately, there is another important pathway to PrEP that Mr. Johnson did not mention. Programs created by the drug company that makes PrEP have provided the medication at no cost to a large proportion of those taking it. For those without insurance who earn less than 5 times the federal poverty level (about $60,000 per year) the company makes PrEP available for free. Those who are underinsured and face a co-pay for their PrEP can receive a card that will cover this expense. These programs are pretty easy to access online.
Also, the UNC community should know that UNC is indeed at forefront of HIV prevention efforts, including for its students. Our Infectious Diseases Clinic provides PrEP services and many who attend our clinic take advantage of the hospital charity care program that covers visit and lab fees. The UNC HIV clinical research unit has also provided access to free PrEP to hundreds of people in our area, including students, through clinical trials. We even have a team that specializes in healthcare provider trainings on PrEP across the state and student health clinics, including Campus Health, have been a priority.
No one should have to jump through hoops to get PrEP, or any medication they need to be and stay healthy. It should not take the tenacity of Mr. Johnson to leap the hurdles insurers have set up to keep their costs down and profits up. Fortunately, work-arounds for getting PrEP despite our arcane heath care system exist — on and off campus. If that does not work and all else fails, email me. We will find a way.
David Alain Wohl, MD
