In 2021, the Biden administration set the goal of ending the HIV/AIDS epidemic by 2030. If the administration is serious about that goal, one action it can take is to reclassify PrEP and PEP (HIV pre‐and post‐exposure prophylaxis) as over‐the‐counter and make them accessible in vending machines.
Using vending machines to make harm reduction accessible to people engaging in underground victimless crimes and to remain anonymous is not a new idea. Kentucky’s first naloxone vending machine opened in a rural part of the state in 2022. Louisville opened one in the exit lobby of its metro jail in September 2023 for people leaving the facility to access, and by December, the machine had dispensed 270 units. A CNN analysis earlier this year found 33 states and the District of Columbia stock vending machines with harm reduction tools for people to freely access. Including PrEP and PEP with those harm reduction tools can reduce the risk of HIV exposure in people who don’t have ready access to health care providers.
Research indicates that taking PrEP daily can decrease the risk of HIV transmission from sex by 99 percent and lower the risk of HIV transmission from needle sharing by 74 percent. PEP, on the other hand, effectively prevents HIV transmission, but people must start it within 72 hours of exposure and stay on it for 28 days. It is advisable to undergo repeated HIV testing from a health care provider after PEP treatment. A randomized controlled trial in an East African region where HIV is prevalent found that PrEP reduced new cases of HIV by 40 percent among men and by 76 percent among women.
Doctors recommend that regular users of PrEP get semiannual blood tests to check their kidney function because long‐term use harms the kidneys. But that’s no reason to require people to get a doctor’s prescription to have access to this lifesaving drug. Nonsteroidal anti‐inflammatory drugs, like ibuprofen and naproxen, can harm the kidneys. People who take them long‐term should also periodically check their kidney function. And long‐term acetaminophen can harm the liver. Yet even minors can purchase lethal amounts of these drugs off the pharmacy or supermarket shelf without a prescription.