The New York City Health Department has been doing amazingly effective, value-neutral messaging with its prevention efforts, identitying at-risk people by blanketing the city with non-stigmatizing testing advertisements, then getting folks into treatment whatever the test results. Obviously, for people who test positive, doctors immediately start antiretrovirals. Perhaps less obviously, they immediately prescribe PrEP for patients who who fit into certain models of risk. No stigma, no moralizing, just medicine — in conjunction with Health Department social workers who figure out how to pay for it.

The goal is to have the treatment begin (if treatment is medically indicated) the very day the patient walks into a clinic to be tested.

I understand that covid interfered with the campaign as resources and priorities had to change, but still, the NYC program is held up globally as a remarkably effective model, not least because its impact is predicted to significantly reduce public health expenditures. It's a lot cheaper in the long run to prevent HIV than to deal with the cost of pervasive (even if low level) rates of continuing infection.

Antiretrovirals are expensive when used for PrEP, of course, but since they're generally only prescribed for a few years during periods of high risk, it makes a lot more financial sense than paying for antiretrovirals for the entire course of a person's life after they seroconvert.

Public health leaders hope this dollars-and-sense demonstration will overcome stigma-based objections to PrEP, though that remains to be seen.