Cullen Smith takes an HIV preventative medication every day for “added security” and “peace of mind” after he thought he may have contracted the disease from a partner last year.
“Once that situation came up, if I wanted to keep my current health, I needed to take other actions,” said Smith, an Atlanta resident. “I was fine, but that was more than enough to make me decide to go for it, because it’s just one less thing to worry about.”
PrEP, or preexposure prophylaxis, comes in a daily oral pill, which can reduce the risk of acquiring HIV through sex by about 99%, or by at least 74% in its injectable form. Smith said he’s been taking the medication for over a year now and although the medication has provided extra protection, he said that if the drug were to get too expensive, or no longer be covered by insurance, he would consider ending his prescription.
“I still have to eat and pay rent. … If it got to a point where I had to pay $1,000 a month, I’d have to reevaluate some things, and I’d probably come off of it,” Smith said.
What Smith describes is a fear that many advocates in Georgia worry could become a reality as the future of PrEP access grows increasingly uncertain due to decisions being made at the federal level.
Earlier this month, the U.S. Preventive Services Task Force — the U.S. advisory panel that determines which preventive health measures, including PrEP, insurers must cover — postponed its third meeting in a row, deepening anxiety among health advocates and patients who rely on the life-saving drug.
PrEP is free under most insurance plans, Medicare, and Medicaid, but without coverage it can cost thousands of dollars for brand-name options.
In a state where HIV rates are some of the highest in the country, and where Black residents struggle to access PrEP compared with their white counterparts due to factors like higher uninsured rates, advocates in Georgia worry that if the federal government chooses to end insurance coverage for the medication, Black folks will be hit hardest by the decision.
“Specifically in Georgia, Black communities are most disproportionately impacted by [HIV],” said Justin Smith, the director of the Campaign to End AIDS at Positive Impact Health Centers, an organization that provides comprehensive care and preventive services to those living with or vulnerable to HIV in the state. “I think that if we see this potential reduction in resources that go to HIV and to public health, that the impact on Black communities would be even greater.”
When asked for comment, a Health and Human Services spokesman said in a statement, “The first [panel] meeting of this year has been postponed and will be rescheduled in the coming months.”
Court decision fails to reduce fears
A year ago, health advocates were less worried about the Trump administration than about another branch of the federal government: the Supreme Court.
The high court had agreed to hear a challenge to the constitutionality of the Affordable Care Act provision mandating coverage of certain preventive services, including PrEP, by insurers at no cost to patients. Two Christian-owned businesses and several Texas residents argued that the mandate ought to be struck down, maintaining that PrEP would “encourage and facilitate homosexual behavior.”
Additionally, they targeted the structure of the Preventive Services Task Force. When the panel assigns an A or a B recommendation to a preventive service — as it has for PrEP — the ACA mandates that insurers cover it with no patient cost-sharing.
For people who rely on PrEP, the stakes were clear: If the court in any way ruled against the mandate, the drug could become unaffordable almost overnight.
Black queer activist Preston Mitchum has been on PrEP since around 2014, two years after the drug was approved by the U.S. Food and Drug Administration. He remembers the barriers many people faced trying to obtain it before 2021, which was the year private insurers were required under the ACA to offer the drug at no cost.
“It was exorbitantly expensive when I first attempted to access it,” he said in 2025, explaining that without insurance covering all or part of it, the medication could run about $2,000 a month.
“No one is ‘accidentally’ on PrEP. It’s a consistent regimen that you have to talk with your medical provider about,” he continued. “The fact that people’s ability to protect themselves could be denied when we say that that’s what we want them to do? That just feels like a slap in the face.”
The court ultimately upheld the task force’s constitutionality. But it also confirmed that the Health and Human Services secretary has the power to appoint its members — and remove them at will. Given Health Secretary Robert F. Kennedy Jr.’s past actions, health advocates say they aren’t confident that no-cost PrEP coverage is secure. Last June, Kennedy, known for undermining established science, abruptly fired every member of a federal vaccine advisory panel, claiming that the move was necessary to “re-establish public confidence.”
Fueling access “in as many ways as possible”
As uncertainty about the future of PrEP access looms, state lawmakers and local organizations are working to increase the drug’s availability.
In Georgia, lawmakers are debating legislation that would allow pharmacists to prescribe PrEP directly to patients. Supporters say that the measure could make the drug easier to obtain by allowing people to bypass a doctor’s appointment and start treatment at local pharmacies.
“By doing this in pharmacies, it’s just a way to try to make sure that more people might find their way to this really incredible prevention tool,” said Smith with Positive Impact Health Centers.
Health advocates say that expanding access to PrEP is key to addressing the racial disparities in HIV prevention, given that Black Georgians continue to face high rates of new HIV diagnoses but have lower uptake of PrEP compared with other racial groups.
According to the latest data from AIDSVu, an online HIV-tracking platform based at Emory University, white residents in Georgia use PrEP at higher rates than Black residents; this pattern reflects nationwide disparities in PrEP use.
“If access retracts, the people who are already marginalized are going to feel it even more,” said Alphonso Mills, community engagement strategist for Positive Impact Health Centers.
And as state lawmakers work to increase access through policy, on-the-ground organizations are working to get PrEP into the hands of residents in more immediate ways.
For people seeking PrEP without insurance, Mills said that staff at Positive Impact Health Centers work with pharmaceutical assistance programs and insurance navigators to help to reduce costs. But accessing the medication doesn’t require a specialty clinic: Smith said that people can also obtain prescriptions through telehealth services that ship medications directly to patients.
“The goal is really to create a system where there’s no wrong door,” Smith said. “We want people to be able to access this incredible prevention tool in as many ways as possible.”
The national telehealth platform MISTR offers PrEP through mail-order care across all 50 states, Washington, D.C., and Puerto Rico.
The company says that it already serves more than 500,000 patients nationwide, and nearly 1 in 3 people using PrEP in the U.S. receives the medication through its service.
Data from MISTR suggests that telehealth may be reaching populations that traditional health care systems have struggled to engage with. About 18% of the platform’s patients are Black, 14% are women, and 35% do not identify as gay.
“Our ultimate goal is to end HIV transmission in the United States. The science already exists. The tools already exist. MISTR is here to make sure the access does too,” a spokesperson for MISTR said.
While the future of PrEP affordability remains uncertain, health advocates say that this isn’t stopping them from continuing the fight to end the HIV epidemic.
“This is certainly a challenging time for all of us who are working in public health, but I think that part of the challenge is making sure that, across the political spectrum, we can make sure that people understand that this is a condition that impacts people across the board,” Smith said.
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