Why scientific breakthroughs won't end HIV if communities are left behind

We are truly in a Dickensian era for HIV prevention advocates: both the best and worst of times. The science is giving us more options. Our politics could leave people with fewer. That stark contradiction, and reality check, sits at the heart of observances like National PrEP Day last weekend, on October 10.More than 14 years after the FDA approved the first pre-exposure prophylaxis, aka PrEP, innovations abound. PrEP is the medication that HIV-negative people can take to prevent acquiring HIV, making it one of the most powerful tools we have to end the epidemic. Not a fan of a daily pill? Long-acting injectable versions are now FDA-approved, including one that lasts for six months. Not a fan of injections? A promising new monthly pill may be on the way. When taken as prescribed, PrEP is 99% effective at preventing HIV transmission through sex.What’s more, “TelePrEP” options are more popular and accessible than ever: MISTR touts access for over 100,000 individuals, Grindr just acquired Freddie to offer PrEP to its platform users, and QCare+ and more continue to bring PrEP directly to people and new audiences. Despite all of this, in-person healthcare support remains the primary pathway to PrEP access in America, and real-life human connection is essential for many of our communities’ most vulnerable people. That’s why community-based clinics remain the foundation of the HIV prevention response in America, and advocates have made enormous progress for us, including passing state legislation to allow pharmacists to prescribe and distribute PrEP. Innovation is encouraging, but on its own, it is unlikely to create equitable access as we face the worst attacks on our HIV and healthcare infrastructure in our history.A six-month injection cannot replace a closed clinic. A telehealth appointment cannot, on its own, repair a broken coverage system. Innovation gives us more ways to prevent HIV; but sustained public investment helps determine who gets to use these li