The American South accounts for more than half of the new HIV cases in the United States, but it is also the most difficult region to find a drugstore or health center that distributes the pill that could prevent transmission.

On Monday (March 11), The Washington Post investigated the challenges that keep PrEP, the once-a-day pill that protects against HIV infection, out of the hands of those who need it. Reports The Post:

In 2017, the last year for which figures are available, the South had about 20,000 new HIV diagnoses—more than the rest of the United States combined. A big reason: In most of the Deep South, it is difficult for people at risk of contracting HIV to find the medication critical to protecting themselves from the virus that causes AIDS and ending the 38-year-old epidemic.

PrEP, which is an acronym for pre-exposure prophylaxis, became available in 2012. It is considered to be 90 percent effective at preventing HIV infection via sex (and more than 70 percent effective at blocking it in drug injections).

“Now that we have this highly efficacious prevention mechanism, it’s about bringing it to scale,” Aaron Siegler, an associate professor at Emory’s Rollins School of Public Health, told The Post.

A major challenge is that not enough health care clinics distribute it. In Mississippi, one of the parts of the country hardest hit by new HIV transmissions, The Post reports that Open Arms clinic distributes 80 percent of the PrEP pills in the state. It is located in Jackson, which has the fourth-highest rate of HIV transmission of all U.S. cities.

Another challenge is cost. A 30-day supply of PrEP can cost more than $1,600, reports The Post. However, in November, the U.S. Preventive Services Task Force recommended that those who are at high risk of contracting HIV take PrEP. Once that recommendation is finalized, insurance companies will be mandated to cover it without a co-payment. Unfortunately, that won’t help people without insurance. As The Post reports, “Among Open Arms clients, 55 percent of the people who start on PrEP are uninsured.”

On Monday, the federal government unveiled new efforts to reduce HIV transmission when President Donald Trump released his budget proposal for 2020. The budget includes a request to deliver a first installment of cash to end the spread of HIV in rural areas including Mississippi. However, that same budget intends to slash Medicaid, which provides critical medical care to many lower-income earning people who already have or are at risk of contracting HIV.

Reports The Post:

The virus is now concentrated in a very small number of places in the United States: the rural parts of seven states, including Mississippi; the District of Columbia; Puerto Rico and 48 hot-spot counties scattered across the country.

[…]

In small, rural towns, one of the problems is hesi­ta­tion to seek the drug because of the stigma of having a same-sex partner, sometimes coupled with racial bias, experts said. Both keep people from seeking care.

Public health experts say that federal money is needed to fund education and outreach programs at health clinics that will encourage people to take PrEP. The path to PrEP is full of little bumps,” Leandro A. Mena, Open Arms’ medical director, told The Post. “And each little bump is an opportunity to drop off PrEP. My job is to smooth the road.”

The multitude of factors that contribute to low use of PrEP is particularly dangerous for Black men who have sex with men, who are more likely to contract HIV than any other group in the U.S. In 2017, they accounted for 26 percent (10,070) of the 38,739 new HIV diagnoses and 37 percent of new diagnoses among all gay and bisexual men in the United States and dependent areas, according to the Centers for Disease Control and Prevention. Adding to the necessity of making PrEP readily available—and affordable—for this demographic, it is projected that half of all Black men who have sex with other men will be diagnosed with HIV in their lifetime.