After making his way through the jungle of American health insurance, Brenton Williams thought he could qualify for PrEP (an acronym for “pre-exposure prophylaxis”or “pre-exposure prophylaxis”), a preventive treatment that prevents the transmission of HIV in the event of exposure. His fiancée being HIV positive, he wanted to have “an extra layer of protection”. But in front of him, his doctor seemed reluctant, admitting that he needed to find out more before any prescription.
This example says a lot about the American delay in terms of knowledge of PrEP. Across the Atlantic, around 60% of the population is unaware of its existence and less than half of doctors feel sufficiently informed to prescribe the molecule. Added to this are persistent stigmas, whether they come from those around them or even the medical profession, as reported by the media Vox.
On paper, however, the United States has all the tools to limit the contraction of new cases. A daily PrEP pill, approved in 2012 by the Food and Drug Administration (the American drug watchdog), helps prevent infection in more than 99% of cases linked to sexual relations with an HIV-positive person. At the same time, the majority of the 1.2 million Americans living with HIV are now on antiretroviral treatment so effective that it makes the virus non-transmissible.
However, Washington faces a paradox: treatments exist, but remain underused. Only a third of people at risk now take PrEP. “We have seen a dramatic decline in new infections over the past fifteen yearsunderlines Carl Baloney Jr., president of AIDS United, the organization responsible for implementing AIDS programs. This dynamic has run out of steam: we have reached a plateau, particularly among vulnerable populations.”
Prevention is fading
Difficulties in accessing pills could well increase. Budget cuts made under the Trump administration have cut hundreds of millions of dollars from prevention and awareness programs. At the same time, an entire generation has grown up without direct memory of the AIDS crisis, which has caused the deaths of 700,000 Americans since the first cases were reported in 1981. “The perception of HIV has changed profoundly since people are living with the disease rather than dying from it»says Danielle Houston, executive director of Southern AIDS, a coalition whose mission is to end epidemics in the South.
In the United States, however, the virus remains very present, with disparities between communities. In Washington, nearly one in fifty residents lives with HIV, one of the highest rates in the country. Nationally, black communities are more affected. “They are more vulnerable to failures in the health system and political changes”explains Danielle Houston. This complicates access to care.
Territorial disparities also illustrate these divides. In states with high health coverage, such as New York or Vermont, new diagnoses fell by 38% between 2012 and 2022. Conversely, in West Virginia and Wyoming, where the population is less insured, cases increased by 27%. Insurance remains a major obstacle for preventive treatment which can cost up to $2,000 (around 1,700 euros) per month without coverage.
Even when it is accessible, PrEP requires a significant commitment, with taking the drug daily and medical monitoring every three months. Result: almost one in two people give up within six months. “We are often told that it is a lot of effort for an illness that you do not have”recognizes Jeremiah Johnson, executive director of the PrEP4All association.
In this context, research is progressing: new alternatives to PrEP are emerging. Lenacapavir was approved in 2025 by the Food and Drug Administration and requires only two annual injections. Other solutions suggest a dose every two months. More than 80% of people who use it continue their treatment after the first six months. For many specialists, PrEP must become as commonplace and accessible as contraception. In the meantime, it is often the patients themselves who must insist. “I have to fight every time»says Brenton Williams. If necessary, he will turn to another clinic.
