Race, class keep­ing many from ac­cess­ing PrEP

GA Voice - - Front Page - By MATTHEW TER­RELL

As a white, mid­dle class, gay man, ac­cess­ing PrEP was in­cred­i­bly easy for me. I took a long lunch break from my full-time job and dropped by my doc­tor’s of­fice for a pre-sched­uled ap­point­ment. There was, of course, a req­ui­site bit of “you know this can’t re­place con­doms” from my doc­tor, but he au­tho­rized me a pre­scrip­tion and sched­uled me for a quar­terly check in. I drove to my phar­macy where the pre­scrip­tion was ready and wait­ing for me. My em­ployer-pro­vided health in­surance had a co­pay of $50, which I guf­fawed at. “You ex­pect me to pay for this?” I thought. The phar­ma­cist told me to pull up the Gilead site on my iPhone and sign up for their pa­tient as­sis­tance pro­gram. Min­utes later, I walked out the door with over a $1,000 bot­tle of pills for free.

I’m in­cred­i­bly priv­i­leged in my ac­cess to health­care and HIV pre­ven­tion. There are few bar­ri­ers be­tween me and free PrEP, and I re­al­ize that some com­plex com­bi­na­tion of health in­surance and govern­ment pro­grams are sub­si­diz­ing my pills. For most of my mi­lieu (white, mid­dle class, gay, in-town res­i­dents), this is a very for­tu­nate part of our re­al­ity. Some of the de­tails for my peers may be dif­fer­ent from my own — per­haps some take MARTA or Uber to the doc­tor of­fice or their in­surance co­pay was a bit higher — but the strug­gle to ac­cess PrEp for this class of gay men is nonex­is­tent. This is why I al­ways roll my eyes at priv­i­lege-blind gays who tout the brav­ery of their de­ci­sion to take PrEP. It’s easy for you.

Many of the most at-risk peo­ple in our com­mu­nity face nu­mer­ous bar­ri­ers when ac­cess­ing PrEP. Ul­ti­mately, these are is­sues of class. Lack of abil­ity to af­ford the con­ve­niences of mid­dle-class so­ci­ety make it harder for lower-in­come peo­ple to ac­cess the same level of health­care.

In At­lanta, par­tic­u­larly, is­sues of class in­ter­sect with is­sues of race. The sys­temic racism of South­ern cul­ture that dis­en­fran­chises peo­ple of color fur­ther keeps them in a lower so­cioe­co­nomic class, thus caus­ing in­creased risk and rate of pre­ventable dis­eases like HIV. Many peo­ple in our com­mu­nity sim­ply don’t have the means to eas­ily ac­cess and ben­e­fit from our profit-driven health care in­dus­try.

The use of PrEP has sky­rock­eted, ac­tu­ally, since its re­lease. But that’s among white men over age 25. The peo­ple who can and are ac­cess­ing PrEP are those with the priv­i­lege to do so. This is why when­ever I see a white, mid­dle-class gay man say, “I can’t be­lieve more peo­ple don’t take PrEP,” I sigh and roll my eyes be­cause they are blind to their own priv­i­lege.

If we want PrEP to be the med­i­cal rev­o­lu­tion that it can be, it’s im­per­a­tive we make the dis­tri­bu­tion of it more equal. Hav­ing a free PrEP clinic is cen­tral to this, and a great first step. But we also have to re­move the bar­ri­ers peo­ple have in even af­ford­ing to go to the clinic. When we talk about PrEP, we need to be talk­ing about how class and race in­ter­sect with HIV in our com­mu­nity.

When we talk about PrEP, we need to check our priv­i­lege first.

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