U.S.A.: Pharmacist urges health care providers to increase PrEP prescriptions as Trump slashes HIV funding

Dr. Ruth Madievsky is deeply concerned for her patients. As a clinical pharmacist focused on HIV care, she has witnessed firsthand the reactions of those she works with to the Trump administration’s hostility towards LGBTQ+ individuals and HIV/AIDS prevention efforts.

In the New York Times, she expressed her anger, stating, “It’s enraging to watch the Trump government, which previously set a goal to eradicate the virus in the United States by 2030, abandon vulnerable Americans and retreat from its longstanding global HIV response.”

Madievsky recounted having difficult conversations with patients about their concerns. One man wanted to start the HIV prevention medication PrEP and asked about the most affordable option available in cash. She explained that his insurance would likely cover the options free of charge, but he worried that using his insurance might alert the government.

“Since I am a clinical pharmacist and do not dispense medications, I asked which pharmacy to send the prescription to,” she noted. The patient was anxious about a prescription creating a paper trail, fearing that recent cuts to HIV care might signal greater threats to come, despite no specific threat to his safety at that moment.

As ‘LGBTQ Nation’ writes, she described this as “one of the most agonizing conversations” of her career, emphasising, “No one should have to worry that preventing HIV could endanger them.”

According to her, these “painful discussions” have only grown as the Trump administration pulls back from the HIV fight.

“For each patient who discloses fears about what will happen under this administration, I wonder how many others are too afraid to seek the care they need altogether,” she stated. “As healthcare providers, we have committed ourselves to protecting our patients from harm. Words of support are not enough to combat policies and rhetoric that could worsen public health inequities for marginalized groups.”

Her proposed solution is to increase PrEP prescriptions to prevent the spread of the disease.

She urged healthcare professionals to routinely screen individuals for PrEP, akin to standard blood pressure checks. “For some, this won’t be difficult; others may need help working through their own biases,” she explained.

“Studies suggest that even many clinicians buy into stereotypes that PrEP encourages people of color to engage in unprotected sexual activity, or that they do not take their medications as instructed,” she said. “Which could allow drug-resistant HIV strains to flourish. Those assumptions contribute to PrEP being prescribed at inequitably low rates. But research suggests these risks are overstated, and they are far outweighed by the ability of PrEP to reduce HIV infections.”

She highlighted the disparities in diagnosis and care, noting, “The incidence of HIV in the United States is about 0.4 percent. But studies have estimated that 14 percent to 42 percent of transgender women are living with HIV. Compared to other women with HIV, transgender women are less likely to receive care that suppresses the virus to undetectable levels in the blood or to have adequate medical care at all. Men who have sex with men represent 67 percent of new infections, and yet Black and Latino men in this group are the least likely to be virally suppressed. Overall, Black and Latino people account for 70 percent of new diagnoses and 61 percent of deaths among individuals with HIV.”

Madievsky warned that the Trump administration’s actions could disrupt HIV/AIDS care and prevention disastrously. While acknowledging that she and her colleagues “certainly cannot avert mass death on that scale,” she stressed that to continue with the status quo would mean surrendering to the future.