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The FDA approved PrEP (tenofovir and emtricitabine) as a once a day single pill in 2012. Since 2014 the CDC has recommended this form of PrEP because it was found to be safe and very effective in the prevention of HIV in high-risk populations. The authors of this editorial review the realities of the current epidemic, address reasons for the underuse of this method and make suggestions for improvement. They quote data from 2016 indicating that of the almost 40,000 new HIV infections about half occurred in black or Latino men who have sex with men, and of all the cases, about 50% occurred in the South of the United States. Although PrEP would be a very appropriate strategy to address prevention under these two circumstances, the reality is that PrEP has been prescribed in less than 150,000 people since coming on the market, and most of the recipients have been white gay or bisexual men living in either the North East or West Coast of the country. Some of the indicated barriers include the presence of stigma, lack of provider knowledge, and limited knowledge among men who have sex with men. In addition, there is the high cost issue and the fact that many insurance plans, if the individual has insurance, still do not cover the use of PrEP. The authors suggest that there is an immediate need for state and city health agencies to partner with CDC in efforts to address the various impediments to use of PrEP. This would include not only educational efforts with professionals but major media attempts to reach the vulnerable populations. There is a wide gap between those eligible for treatment and those receiving it. There will need to be a concerted effort by the affected communities from addressing insurance companies not providing coverage to dealing with the presence of continued stigma in the community. The number of new HIV cases has been persistent over the recent years, and the authors make a strong case that now is the time to do something about it.
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