Truvada may also slow the spread of HIV among black gay and bisexual men. According to a new report released this week by the Black AIDS Institute, black gay and bisexual men make up nearly one in four new HIV infections, though they account for only one in 500 people living in the U.S. By the time a black gay man reaches age 25, he stands a roughly 1-in-4 chance of being infected with HIV. “For the most at-risk population on the planet — black gay and bisexual men — this approval is not a moment too soon,” says Wilson.
The challenge will be reaching them. Many have been driven away from health care and other services by negative experiences and are isolated from family and other support because of homophobia. “We now need to find a way to deliver this drug to where they are,” Wilson adds.
And, for this medication, price is an object and a point of contention. Truvada has been on the market to treat HIV since 2004, and it’s generally covered by health insurance. At this point, it’s unclear whether insurance companies will pay for Truvada for prevention. A year’s supply costs $13,900, according to Gilead Sciences, the drug’s manufacturer.
Currently, more than 2,000 HIV-positive Americans are stuck on waiting lists, unable to afford lifesaving medications. The bulk of those without access to treatment live in the South, and most are people of color. So in a time of strained financial resources, who should get the drugs — the sick, or the healthy who want to stay that way?
The issue of access and affordability is most pressing in East and southern Africa, the areas of the world most heavily affected by the HIV epidemic. Ironically, Truvada’s most promising results — 75 percent reduction in HIV transmission among couples in Kenya — occurred in Africa, which needs a preventive treatment desperately but may never be able to afford it. Of an estimated 10 million HIV-positive Africans, only half receive medication, which leaves nothing to spare for prevention.
Still, Dr. Clement Chela, the director general of Zambia’s National AIDS Council, says that he will do whatever it takes to get preventive medication to his country. Zambia is one of the hardest-hit regions in the world, with 14.3 percent of the population infected with HIV. About a third of those who need HIV-fighting medication do not receive it.
“We will work hard to make sure to make this drug available to Zambians, despite the cost,” Chela said by email shortly after the FDA announced approval. But he was quick to add, “We would not like to use such an expensive drug for this purpose until we are able to put more people on ARVs [antiretrovirals].”
Activists urge that even as the science races ahead, people of color must be in the forefront of HIV/AIDS decision making. “This medication has been approved, but it’s just the beginning,” says Fields. “We have to be at the forefront as PrEP rolls out into the black community. It’s critical that we make our voices heard.”
Linda Villarosa runs the journalism program at the City College of New York and writes frequently about HIV/AIDS and other health issues.