Confronting the HIV Epidemic: Addressing Gaps in Access, Adherence, and Equity
At AMCP 2025, health care leaders Maria Lopes, MD, and Steve Cohen, MD, highlighted the persistent and unique challenges of HIV management in the US, emphasizing that despite medical advancements, HIV remains classified as an epidemic. With over 1.2 million Americans living with HIV and more than 38 000 new diagnoses annually, the burden of this disease disproportionately impacts minority populations, particularly Black and Hispanic communities. Dr Lopes underscored the significant role that social determinants of health—such as poverty, homelessness, disability, and lack of access to transportation—play in limiting treatment access, decreasing adherence, and impeding viral suppression efforts.
In addition to social and economic barriers, stigma remains a critical challenge across every stage of the HIV care continuum, from prevention and testing to treatment. Misconceptions about HIV and those affected by it lead to discrimination, discourage individuals from seeking care, and contribute to poor health outcomes. Unlike other chronic conditions, HIV is uniquely stigmatized, further complicating efforts to reduce its spread.
Strategic Interventions and the Path Forward
Dr Cohen emphasized the urgent need for strategic interventions, noting that the progress in reducing new HIV infections has stalled. The US Department of Health and Human Services’ "Ending the HIV Epidemic" (EHE) initiative, launched in 2019, aims to reduce new infections by 75% by 2025 and by 90% by 2030. This initiative is anchored by 4 key strategies: diagnose early, treat effectively, prevent transmission (particularly via pre-exposure prophylaxis or PrEP), and respond swiftly to outbreaks. Six performance indicators, including diagnosis rates, viral suppression, and PrEP uptake, are used to measure progress.
Despite the availability of PrEP, which reduces the risk of acquiring HIV by up to 99%, utilization remains strikingly low, especially among those at highest risk. Of the 1.2 million individuals eligible for PrEP, only 36% are receiving it. Alarmingly, the populations most affected by HIV are also the least likely to receive PrEP, a disparity that is amplified by systemic inequities and access challenges. Delays in PrEP access, high out-of-pocket costs, and insurance-related obstacles significantly increase the risk of new infections, with studies showing that those who abandon PrEP due to cost are 2 to 3 times more likely to contract HIV.
Bridging Gaps and Removing Barriers
Both speakers emphasized that eliminating barriers to PrEP and treatment is not only medically urgent but also economically sound. The lifetime cost of treating an individual with HIV is estimated to be $850 000 more than for an HIV-negative individual. Therefore, preventive efforts such as increasing PrEP accessibility and adherence can yield substantial cost savings while improving public health outcomes.
To help end the epidemic, Dr Cohen advocated for practical policy changes—such as ensuring $0 cost-sharing for PrEP, removing annual limits on HIV testing, and streamlining prior authorization processes for long-acting injectables. These changes could address coverage gaps and reduce administrative burdens that delay care. Ultimately, both experts concluded that overcoming the epidemic will require a multipronged approach that addresses social, structural, and systemic barriers—alongside continued education and stigma reduction efforts—to ensure equitable access to HIV prevention and care for all.
Watch the full video series with leading voices in HIV care as they outline the path to prevention, equity, and sustainable cost management.
Reference
Video series on HIV in focus: addressing challenges and opportunities. First Report Managed Care. Published August 19, 2025. Accessed September 2, 2025. https://www.hmpgloballearningnetwork.com/site/frmc/video-series/video-series-hiv-focus-addressing-challenges-and-opportunities
