Federal HIV prevention efforts in the U.S. have stalled because the country has largely stopped tracking progress, a leading researcher said.
Raphael J. Landovitz, a professor of medicine at UCLA’s David Geffen School of Medicine and director of the UCLA Center for Clinical AIDS Research & Education, stated that surveillance systems for pre-exposure prophylaxis (PrEP) uptake have become unreliable. Without dependable data, assessing how many people still lack access to the medication or understanding the reasons remains impossible.
Landovitz expressed concern about the situation. “We’re not doing enough,” he said in a recent discussion. “I find that terrifying.”
Medicaid gaps and funding cuts leave vulnerable groups behind
The Ryan White HIV/AIDS Program, a federal initiative providing care for people living with HIV, was not designed to support PrEP distribution. That limitation forces prevention efforts to rely on other funding sources, many of which are disappearing.
States that haven’t expanded Medicaid increasingly reject federal prevention funds, shrinking the safety net for patients who depend on it. The trend particularly harms lower-income groups, racial and ethnic minorities, and LGBTQ+ communities—populations that prevention programs previously reached.
Landovitz described the shift as backsliding, widening existing disparities in access. The issue extends beyond funding. Even when programs exist, structural barriers prevent many from using them.
Stigma around HIV, medical mistrust, and competing priorities like housing instability or mental health needs often push preventive care aside. For those managing substance use, the obstacles can feel overwhelming. Substance use disorders further complicate access to care.
High costs and payer obstacles limit access to newer PrEP options
Injectable PrEP, which provides longer-lasting protection than daily pills, faces its own challenges. Landovitz identified pricing as a key issue, with insurers and pharmacy benefit managers creating barriers that affect both initial access and ongoing use.
Patients with resources typically overcome these hurdles. Those without, especially people already marginalized by the healthcare system, struggle to gain access. The outcome is a divided system where prevention remains available to some but unattainable for others.
Political divisions have worsened the situation. As debates over healthcare funding and LGBTQ+ rights grow more heated, gaps in education, services, and resources expand. Without focused efforts to address these inequities, HIV prevention will keep failing those who need it most.
The absence of clear data complicates measuring progress or defining success. Until surveillance improves, the U.S. will remain unaware of how many people are still excluded from prevention efforts.
