The landscape of HIV prevention has transformed over the years with the miraculous development of medications like preexposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) that can prevent HIV infection. HIV diagnosis once meant a death sentence, but today, people can live long and healthy lives. 

Some states are using legislation to make even more significant dents in HIV infection rates. This year, for example, California Gov. Gavin Newsom signed Senate Bill 339, which authorizes a pharmacist to furnish up to a 90-day course of PrEP or PEP beyond a 90-day course if certain conditions are met. SB 339 is intended to close loopholes from a similar 2019 bill that made California the first state in the nation to allow pharmacists to provide PrEP without a doctor’s prescription, as the bill’s limitations prevented wide implementation across the state. Newsom’s signing of SB 339 marked a much-needed step in the right direction, but there’s one major problem: The bill still fails to address education and marketing. What good are these services if communities aren’t aware they exist?

When Newsom signed the 2019 bill, at first glance it seemed groundbreaking. But the legislation fell flat by not taking into account the need for long-term care. Even Richard Dang, the former president of the California Pharmacists Association, which sponsored both bills, told the San Francisco Chronicle that there was “very low uptake” of the services offered by the legislation.

In rectifying these loopholes, California has missed the mark once again because it does nothing to ensure that communities with little to no information on HIV prevention medication are aware of the services. 

Already, there is a lack of public knowledge on the present landscape of HIV prevention and treatment. I went to a public high school in California, and even our semester-long sex education course failed to acknowledge prevention options beyond abstinence and condoms. It was not until I attended college that I heard through word-of-mouth about modern, groundbreaking treatments like PrEP that can reduce the risk of getting HIV from sex by about 99%. 

According to the Centers for Disease Control and Prevention, Black and Latino communities could most benefit from PrEP, but few have been prescribed the medication. If California’s legislation is to succeed in its mission to increase access to medication, then there needs to be a greater focus on marketing and education to let the community know about these new policies. 

I experienced hurdles in accessing information during my research—even though I had time to focus strictly on this topic. For example, I couldn’t figure out whether I could simply walk into a pharmacy and request PrEP like an over-the-counter medication or if I had to see a health care provider first. Additionally, the PrEP Assistance Program (PrEP-AP) Clinical Providers and Enrollment Sites map was not easy to find. This is a valuable resource for uninsured people, but what good is it if they can’t find it or don’t know it exists? What are people supposed to do when they don’t have the time or resources to hunt down this information—especially those from California’s sizable immigrant community who may not speak English and who often lack access to health care more broadly?

The California State Board of Pharmacy has until Oct. 31 to adopt emergency regulations to implement the bill. In that time, policymakers need to devise a plan to push for more education access in schools and throughout California communities. Sex education courses within public schools should inform teenagers of free PrEP assistance programs. Social workers who visit local community centers like the YMCA can also discuss treatment options with the public. Policymakers need to take the lead in reframing the health care narrative. Rather than consumers seeking treatment information, policymakers must evaluate how treatment information can reach consumers. California has the resources to create an education-centered and accessible health care landscape for all.

There is already immense stigma regarding sexual health—especially when it comes to the topic of HIV. Instead of putting the onus on the public to ask for help, California needs to expand the new bill’s reach by addressing common concerns, including those related to privacy that deter even insured individuals from seeking treatment—especially young adults on their family’s insurance plans. 

Without insurance, a full course of PEP can cost between $600 and $2,500, making the medicine virtually unaffordable to most Americans. The cost of PrEP is even more expensive without insurance, potentially reaching $22,000 to $30,000 annually. Many uninsured people in California are also unaware of telehealth programs in the state that can connect them to clinical providers.

There are indeed many ways that California has bridged the gap in medical access, which is no surprise given California has historically been a leader in progressive health policies. In 2013, state lawmakers passed a bill authorizing pharmacists to prescribe birth control, smoking cessations, and medications for traveling abroad. Health-related bills from California have shown great success. SB 339 has similar potential; it just needs better marketing so that it can help the people who need it and serve as a nationwide model for other states to follow.

California is just one of a handful of states with legislation for HIV prevention treatments. PrEP and PEP, like other medications related to sexual activity, often face religious and moral objections from Republican-controlled states. They view access to PrEP and PEP as an individual responsibility, not a public health concern—an absurd belief, given that HIV “remains a major global public health issue,” according to the World Health Organization. 

As health access contradicts religious biases, in many states, it’s difficult to pass bills to protect communities when white Christian nationalists successfully argue that access to certain forms of care violates their religious rights. For example, in a 2022 Texas lawsuit, plaintiffs refused to offer health care coverage that included HIV-prevention medication like PrEP, arguing it violated their religious freedom. A federal judge agreed.

But bills that expand health care access are still circling—even in Republican-led states. Earlier this year, a bill similar to California’s SB 339 was introduced in Louisiana, a state which in 2021 had one of the highest rates of new HIV diagnoses in the country.

California’s bill comes at a significant time. There are more HIV treatment and prevention options than ever before, and even Republican-led states are considering similar efforts. 

Not only can California create a working model, but the state can show that the Ending the HIV Epidemic in the U.S. (EHE) initiative to reduce the number of new HIV infections by 90% by 2030 is possible—and necessary. The components needed for the California bill to work are in place; policymakers just need to properly implement the legislation on a public level.

It’s crucial to demand that policymakers not only pass bills that transform the health care landscape, but also take steps to ensure bills’ offerings are known and accessible. We need outreach groups in vulnerable communities, ad campaigns across all digital platforms, and science-based sex education in public schools. 

California has the potential to be a leader in the fight against HIV by offering a tangible solution to stopping new cases from emerging and showing the power of embracing science and evidence-based approaches to problems rather than leading with religious biases and harmful stereotypes.

With more loopholes closed by SB 339, the last thing for California to do is what the state should have done all along: let the public know.