For Michael Chancley Jr., PrEP advocacy is both a personal and professional matter

For Michael Chancley Jr., preexposure prophylaxis (PrEP) is both personal and professional. As communications and mobilization manager for PrEP4All, he is based in Atlanta, where he also leads the organization’s PrEP Users Union, a group of nearly 100 racially and gender-diverse individuals on PrEP. He is 40 years old, Black, gay and has been taking PrEP since 2015.

Initially, Chancley was hesitant to begin PrEP, a decision he now attributes to internalized stigma.

“I was in the community. I was doing the work. I was like, ‘That’s not for me,’” he said. “But it’s like, ‘No, you are a sexually active individual within this community who does not always have consistent condom usage. This is for you, just as it’s for the community that you serve.’”

Chancley began his career as a social worker and HIV advocate in New Orleans, where he was born and raised.

There, he became increasingly passionate about LGBTQ advocacy, especially its intersection with racial equity.

“When I looked at a lot of mainstream LGBTQ advocacy, I didn't really see Black faces. I would go to Human Rights Campaign events, and it didn't look as racially diverse at that time.”

PrEP is approximately 99% effective at preventing HIV, but only when it is accessible.

Organizations like PrEP4All are working to close that gap. The nonprofit advocates for a federally funded National PrEP Program for uninsured and underinsured individuals while also focusing on protecting HIV program funding and strengthening community engagement.

Chancley’s PrEP journey began with a visit to a primary care provider who was unfamiliar with PrEP. Chancley said he was “lucky” to be able to advocate for himself, sharing resources from the Centers for Disease Control and Prevention. After reviewing the information and completing the required lab work, including a negative HIV test, his provider prescribed Truvada.

Approximately 591,475 people are using PrEP in the United States; however, just 36% of the 1.2 million people who are candidates for PrEP are currently on it. Uptake remains particularly low among women and people of color, driven in part by longstanding sexual, racial and gender-based disparities in healthcare access and trust. PrEP has evolved significantly since its introduction. The FDA first approved Truvada (tenofovir/emtricitabine) in 2012 as a daily oral medication for individuals at risk of HIV through sex or injection drug use. In 2019, Descovy (emtricitabine 200 mg/tenofovir alafenamide 25 mg) was approved for sexually active men at risk of HIV. More recently, long-acting options have expanded access, including Apretude (cabotegravir), an injectable given every other month and Yeztugo (lenacapavir), approved in 2025 as the first twice-yearly injectable form of PrEP.

Today, Chancley uses an on-demand generic version of the medication, a switch he made during the COVID-19 pandemic. His experience with PrEP has been positive, but he said misinformation among providers remains a barrier.

“I’ve had doctors greatly exaggerate how ineffective PrEP is, giving percentages that were just pulled out of nowhere,” he said. “Before we can convince the community, we have to convince providers and leaders within these organizations that PrEP is safe and effective.”

Stigma continues to shape both access to and perceptions of PrEP, particularly in marginalized communities. Chancley pointed to historical medical mistrust as a major factor.

“We have very legitimate, historic reasons why people don’t trust preventative care, whether that be birth control, PrEP or vaccines,” he said. “When you don’t address the biases and medical mistrust that communities have, it comes off as, ‘Why are they pushing this on our communities?’”

Still, he was shocked by the reality when he entered the field.

“If you would have told me back then that by 2026, you would have 94% of White people who could benefit from PrEP on it, but only 14% of Black people who could benefit from PrEP are on it, I wouldn’t have believed it.”

Chancley explained that this is further complicated by the current U.S. political landscape, where federal funding cuts have impacted Chancley’s work, specifically the Trump administration's elimination of many federal Diversity, Equity and Inclusion (DEI) programs.

He said one of the biggest shifts in his advocacy appears in his conversation with clinic patients, stating that when he entered the field, conversations about PrEP were more about being proactive, focusing on the location of clinics and what medication assistance programs were available to them.

“We're still out there educating people about the resources that do exist, but we’re also having to answer questions about threats to the resources that people rely on.”

This is especially true for Chancley, who is a member of the community that he serves.

“Even when I take my work hat off and I go into the community, people are concerned, and they ask me, because I'm the closest that they know, even when I don't have the answers. I can let them know what advocates are doing and how they can support and get involved, but I can't give the concrete answers that people want to soothe their fears.”

He acknowledged that addressing inequity also requires self-reflection, sharing a story about a realization he had during a sexual education class he was teaching. As a part of every presentation, he would show the same CDC video about PrEP, which only featured young, gay men. He thought nothing of it until one day, a young woman in the class asked when they would come out with PrEP for women.

“It changed how I engage the community around education and made me realize, in some ways, you even perpetuate the things that you call out. That's about checking our own egos and knowing we have to pivot and reevaluate constantly.”