Raphael J. Landovitz, M.D., on PrEP access barriers in the US | AIDS 2026

Asked whether increased PrEP uptake in the U.S. is a slow grind toward progress or a plateau, Raphael J. Landovitz, M.D., gave a blunt answer: neither, because the country has largely stopped measuring it. Landovitz is professor of medicine and chief of the division of infectious diseases at the David Geffen School of Medicine at UCLA, where he also directs the UCLA Center for Clinical AIDS Research & Education.

In this video, Landovitz discusses the barriers standing between newer PrEP options and the U.S. patients least likely to access them.

"I don't think we're getting there. No, I don't think we're doing enough," Landovitz said, adding that HIV prevention surveillance has "gone into a black box," making it difficult to know the true scope of unmet need. "I find that terrifying," he said.

Landovitz said Ryan White HIV/AIDS Program funding is less of a factor, since it was built around people already living with HIV rather than PrEP programming. The bigger threat, he said, is states that have not expanded Medicaid increasingly turning down federal prevention dollars, squeezing the safety net programs that help patients access and stay on PrEP. He called that trend a form of backsliding for the lower-income, racial and ethnic minority, and sexual and gender minority populations prevention programs had been reaching.

Pricing of injectable PrEP products is compounding the problem, Landovitz said, creating payer obstacles that complicate both initial access and long-term persistence on therapy. Well-resourced patients, he said, will generally find a way to get the products they need. The people left out are those managing stigma around HIV treatment and prevention, medical mistrust, mental health or substance use disorders, or competing life priorities that take precedence over preventive care. Landovitz argued that until those social and structural barriers are addressed directly, engaging those populations in HIV prevention services will remain difficult, and he said growing political polarization only widens the resulting disparities in education, services and resources.