Sec. 2. Findings; sense of Congress

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Congress finds the following: The Centers for Disease Control and Prevention estimates that approximately 1,200,000 individuals in the United States are living with HIV. In 2021, there were 36,136 new diagnoses of HIV in the United States. HIV disproportionately impacts gay and bisexual men, transgender women, and, in particular, people of color. In 2021, approximately 71 percent of new HIV diagnoses were estimated to be among gay and bisexual men, 40 percent of new HIV diagnoses were among Black people, and 29 percent of new HIV diagnoses were among Latinx people.

Recent studies suggest that transgender women are up to 49 times more likely to be diagnosed with HIV than the general population. Members of communities at the intersections of these groups are most heavily impacted. Pre-exposure prophylaxis (referred to in this section as PrEP ) is a daily antiretroviral medication that helps prevent individuals from acquiring HIV. Daily PrEP use reduces the risk of getting HIV from sex by more than 99 percent. It reduces the risk of getting HIV from injection drug use by at least 74 percent.

Many individuals at risk of exposure to HIV do not use PrEP. Of the approximately 1,200,000 individuals in the United States who could benefit from PrEP, only 31 percent, or 382,364 individuals, filled prescriptions for the drug in 2022. PrEP usage is inconsistent across racial and gender lines. In 2022, only 11 percent of Black/African American and 21 percent of Hispanic/Latinx individuals who were eligible for PrEP were prescribed it, compared to 82 percent of eligible White individuals.

PrEP usage is low among women, in particular among heterosexual women of color. Slightly less than 12 percent of women eligible for PrEP received a prescription in 2022. PrEP use helps strengthen families by allowing couples with partners of different HIV statuses to prevent the transmission of HIV. There are currently 2 brand name drugs and 1 generic drug approved by the Food and Drug Administration for the use of PrEP on a daily basis. A long-acting injectable PrEP drug has also been approved by the Food and Drug Administration.

Other types of HIV prevention treatments, including other long-acting injectables, long-acting oral pills, implants, and vaginal rings are in the research pipeline. These innovations can increase widespread use of PrEP along with adherence, which can speed the Nation’s goal to end HIV and address inequities in health care. Section 2713 of the Public Health Service Act ( 42 U.S.C. 300gg–13 ) requires non-grandfathered private health insurance plans to cover preventive services without cost-sharing, including such services with a rating of A or B under recommendations of the United States Preventive Services Task Force.

On June 11, 2019, the United States Preventive Services Task Force issued a final recommendation giving an A grade for PrEP for individuals at high risk of HIV; non-grandfathered private health insurance plans have to cover PrEP for such individuals without cost-sharing effective January 2021. Updated United States Preventive Service Task Force guidance incorporating the new long-acting injectable PrEP drug is pending. Joint guidance issued by the Department of Labor, the Department of Health and Human Services, and the Department of the Treasury on July 19, 2021, clarifies that ancillary services necessary to maintain the PrEP regime, including subsequent provider visits, clinical testing, and other services, is required to be covered by health insurers without cost-sharing.

Permanently expanding access to cost-free PrEP and ancillary services for all individuals, including individuals who do not have health insurance, through legislation, is a critical step towards eliminating HIV transmission. Post-exposure prophylaxis (referred to in this section as PEP ) is a daily antiretroviral treatment which, when initiated promptly after a sexual or other exposure to blood or body fluids that are associated with a high risk of HIV transmission, is highly effective at preventing HIV transmission.

The Centers for Disease Control and Prevention recommends PEP for an individual who has experienced a high-risk exposure incident, provided that the individual tests HIV-negative, initiates such treatment not later than 72 hours after exposure, and continues the treatment for 28 days. Despite PEP’s proven effectiveness in preventing HIV transmission after high-risk sexual exposures, including sexual assault, awareness of PEP is low among individuals who would benefit from the treatment.

Studies suggest that awareness of PEP and of the importance of its prompt initiation is particularly low among young gay and bisexual men of color, transgender individuals, and women of all gender identities. Adequate knowledge of guidelines issued by the Centers for Disease Control and Prevention for assessing indications for PEP and for initiating and sustaining PEP are low among health care providers and staff. Because PEP is an emergency intervention, insufficient knowledge among providers and staff in hospital emergency rooms, urgent care centers, community health centers, and primary care physicians is of particular concern.

Private and public health insurance plans and programs frequently impose requirements for coverage of PEP, including pre-authorization requirements and requirements to obtain the medications through designated specialty pharmacies and mail-order programs that pose significant obstacles to timely initiation of treatment. Insurance deductibles and co-payments for PEP medications create significant barriers to PEP utilization by many individuals who have experienced high-risk incidents.

The Federal Government has a compelling interest in preventing new cases of HIV. Lowering the prevalence of HIV protects public health and saves on the cost of HIV treatment. It is the sense of Congress that the Department of Labor, the Department of Health and Human Services, and the Department of the Treasury should ensure compliance with the requirements described in paragraphs

(9)and

(10)of subsection (a).

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42 USC 300gg–13

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Sec. 2

Findings; sense of Congress

Cite42 USC 300gg–13

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