In a move aimed at improving statewide public health outcomes, the Mass. Senate on Oct. 26 unanimously passed two bills that would expand access to HIV preventive medication and free menstrual products. The Senate had approved both bills at the end of the last legislative session, but amid the flurry of bill trading time ran out and neither was signed into law.
State Sen. Julian Cyr, who chairs the Joint Committee on Public Health, is optimistic about the two bills’ chances in this session. If enacted, the first would authorize pharmacists to prescribe, dispense, and administer PrEP, or pre-exposure prophylaxis, and task the state Dept. of Public Health (DPH) with giving pharmacists the information and training to do it effectively.
When taken as prescribed, the once-daily PrEP pill can reduce the risk of HIV transmission from sexual contact and injection drug use by about 99 percent and 74 percent, respectively. Yet the use of PrEP has remained uneven since its FDA approval in 2011.
A 2020 survey by the Centers for Disease Control and Prevention indicated that about 23,000 people were living with an HIV infection in Massachusetts — an increase of 16 percent since 2011. Of the additional 25,000 people considered at high risk for HIV transmission, only about one-third had been prescribed PrEP. Those without prescriptions are disproportionately people of color, the gay male and transgender community, and injection drug users.
“PrEP is how we get to zero HIV infections,” said Cyr, the lead sponsor of the bill, this week.
In pushing for the PrEP bill, Cyr drew on his six years working for the DPH and his contacts in LGBTQ advocacy groups. As someone who takes PrEP daily, he said, he understands how the need for the medication sometimes arises unexpectedly for both those with active prescriptions and those without — and how delays caused by having to schedule a doctor’s appointment can exacerbate transmission risk factors.
The bill endeavors to dismantle that barrier. Pharmacists would be able to directly prescribe PrEP as long as the client has tested negative for HIV within the previous seven days, displays no HIV symptoms, and takes no medications unsafe for use with PrEP. The pharmacist would connect the client to a primary provider for necessary follow-up care.
The fiscal 2024 state budget would work in tandem with this bill to ensure that PrEP, once prescribed, is covered by insurers without patient cost-sharing. Organizations like the AIDS Support Group of Cape Cod can connect people with programs that help them navigate the health system and eliminate other medical copays and expenses.
CEO Dan Gates of the AIDS Support Group testified before the Senate in support of the bill and plans to do so again as it moves to the House of Representatives. While Gates said he thinks health-care providers on the Outer Cape generally understand HIV transmission risks and the importance of PrEP prescriptions, he added that it isn’t always the case. Preventive care must be broad and creative, he said.
“There’s no wrong door in getting people connected to care that should be an inherent right,” said Gates.
The second bill, informally known as “I AM,” would provide free and easily accessible menstrual hygiene products to public schools, correctional institutions, and homeless shelters throughout the state. Locally, it would support Sheriff Donna Buckley’s goal of making these products more accessible at the Barnstable County Correctional Facility.
While Massachusetts does not tax pads and tampons as nonessential items as many other states do, the cost of menstruation products averages more than $20 per cycle. For youth living in poverty, the arrival of a monthly period can mean missed time in class. For unhoused or incarcerated people, a period could exacerbate other vulnerabilities. There have been reports of menstrual products being withheld or used as coercive tools.
A coalition of advocates, including organizations like Mass NOW and Love Your Menses, see the “I AM” bill as an essential step in destigmatizing menstruation and combating period poverty. They credit the grassroots organizing of young people with drawing attention to this need through local menstrual product drives and social media advocacy.
“We are taking on issues of public health, economic inequality, educational equity, and gender equity all at once,” said Mass NOW executive director Sasha Goodfriend in a press release. “It’s one of the best examples of intersectional lawmaking and feminist policy.”