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President Trump’s ACA Repeal is stirring up emotions on many sides. Some of those strong emotions are coming from the PrEP (Pre-Exposure Prophylaxis for HIV/AIDS) population. @VernumVulero1 beautifully covered a lot of ground with her take on ACA and AHCA, and I tend to agree with most of it. As someone who utilizes Truvada as PrEP and may be affected by ACA repeal and replacement, I’m addressing the fear mongering and how it directly relates to me.
Many co-pay assistance programs are in danger of having funding cut because of Trump’s ACA Repeal. Co-pay assistance programs that many (including myself) utilize thanks to drug manufacturer Gilead and other non-profit organizations that make access to PrEP and other drugs less expensive. But we have all read the fine print and understand that these co-pay assistance programs were never meant to last and could be taken at any day at any time by the drug manufacturer, whether federal funding existed or not. If and when these events happen, we should not be surprised. We should have a backup plan ready to go. Since day one, I've always filled my prescription as soon as I am allowed so that, in the untimely event that the co-pay assistance or coverage under my provider no longer exists, I can come up with a contingency plan to continue or discuss antiquated prevention methods and my health post-PrEP with my doctor.
Another concern is how Truvada will be unavailable to those who have an insurance program through the marketplace. I can’t speak for what will happen, but what I do know from a few friends is that many marketplace plans either will not cover any portion of the drug or will only cover portions of the drug if someone is in a serodiscordant relationship (where one has HIV, and the other does not). As for insurance plans through one’s workplace, many people with different illnesses and treatments share the same concerns under the repeal of ACA. I’m not willfully ignorant: I’m aware at any moment coverage of Truvada under my healthcare plan may end. But unlike many, I always had those concerns because nothing is a complete guarantee. It wasn’t under President Obama (“If you like your plan, you can keep your plan.”) and it won’t be under President Trump.
Far beyond pillow talk and the ordering of pizza, this is the post-coital reality we need to accept: PrEP allows us the freedom to take control of our sexual health and allows us not to be completely reliant on the word of someone else or their application (or lack thereof) of a condom. But it should also give us the freedom to manage the acquisition of the drug and payment of the drug by any means necessary. We should never believe that any one government program, government organization, or nonprofit has our best interests completely at heart. Have we yet to learn anything from AIDS Healthcare Foundations, their use of nonprofit funds for real estate, their “War on PrEP,” and their avid slut-shaming of the MSM population for sport?
Our efforts as users of PrEP should be to mobilize and build nonprofits that will exclusively subsidize these drugs (and drugs for those who are living with HIV) for years to come, with little to no assistance from the government. Our efforts as individuals should be to find health insurance companies and/or work for employers who care enough about our health and our contributions to the workplace that will cover as much of it as possible. Our efforts should be to legally obtain these drugs by other reputable means (whether it is crossing state lines or even traveling out of the country to obtain them). Our efforts should never be to move backward and believe that President Trump will take advancements of HIV/AIDS back to 1981.
Our use of Truvada as PrEP has always been an amazing privilege. It has never been a “right” given to us by the government, nor should it be. I don’t want a government that dictates what my prophylaxis measures should be, what partners I choose to entertain in my bedroom, nor what kind of sex I should have. I also don’t want a government (be it under Obama or Trump) that feels the need to deem what is most important for my health and my existence. I don’t want the government (or any other entity) to have that kind of power over me or my sexual freedom.