Race, class keeping many from accessing PrEP
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.