Protecting Californians from HIV
Dr. Stef Bertozzi and Dr. Lauren Hunter outline path to more patients receiving lifesaving HIV prevention medications
Published July 30 | By University of California, Berkeley
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The challenge: Determine why Californians were not accessing HIV medications, despite state laws making them more accessible.
Roughly 1.2 million people in the United States are living with human immunodeficiency virus, commonly known as HIV. Left untreated, HIV can advance to become AIDS, a lethal disease which has killed more than 700,000 people in the U.S.
HIV spreads through specific body fluids—blood, semen, vaginal fluids, rectal fluids, and breast milk—most commonly through unprotected sex, shared needles, or perinatal transmission, according to the National Institutes of Health.
In recent years, HIV—once considered a death sentence—has become treatable and preventable. Medicines called antiretroviral therapy (ART) have made it possible for most people with HIV to live long and healthy lives. An HIV treatment regimen generally includes three HIV medicines from at least two different HIV drug classes that must be taken exactly as prescribed. There are several options that have two or three different HIV medicines combined into a once-daily pill. And people who meet certain qualifications, can receive their medication via a long-acting injection.
Another critical category of HIV medicines called pre-exposure prophylaxis (PrEP)–given to people who do not have HIV–reduces the risk of getting HIV from sex by about 99% and from injection drug use by at least 74%.
Despite the development of these medications, about 31,800 new cases of HIV continue to be diagnosed in the U.S. each year—5,000 in California alone. Still, that’s a marked improvement from the epidemic’s peak in 1984 and 1985, when between 130,000 and 150,000 were diagnosed each year nationwide.
But with such efficient medications, why are so many people still getting infected with HIV? Weren’t there laws passed in California a few years back to make the PReP medications available to anyone who asked for them in a drugstore? What happened?
To make the PrEP drugs more widely accessible, the state of California did, in fact, enact a law that enabled pharmacists to prescribe an initial 60-day supply of PrEP in 2019, but when few pharmacists participated, the lawmakers passed a second bill in 2024 to permit pharmacists to provide ongoing PrEP care.. But again, there was little uptake.
What the research found: There were too many roadblocks for pharmacists to effectively offer the medications. Removing those barriers should boost accessibility for Californians.
Two studies led by Dr. Stefano M. Bertozzi, a UC Berkeley Public Health professor and longtime AIDS expert, and Dr. Lauren Hunter, a UC Berkeley epidemiology postdoctoral scholar, got to the bottom of what went wrong with the state’s PrEP program, and point the way to better access to HIV prevention and care.
“This question was an important one for lots of stakeholders interested in increasing access to PrEP in this way,” Bertozzi said, “not the least of which was Sen. Wiener who co-authored the legislation; and advocacy groups, like our collaborators the SF AIDS Foundation.”
The study, led by Bertozzi and Hunter for the California HIV/AIDS Policy Research Centers and published in April 2026, found that out of 910 pharmacies surveyed, only 31 offered pharmacist-initiated PrEP services and of those, only five offered the long-acting injectable (LAI) medication, which the public health community believes many patients would prefer over taking pills every day.
“We have very low implementation, even though California has had a very favorable policy environment,” said Hunter. “This study, six years after legislation first permitted pharmacists to offer PrEP services, shows very few pharmacies are actually providing it in practice.”
She and Bertozzi are now studying the barriers to implementation, among them: the difficulty for pharmacists to get reimbursed for their time in addition to the medication; pharmacy workflow and staffing constraints; and low awareness of pharmacist-initiated PrEP services. The researchers are recommending policy changes for state lawmakers to address these roadblocks. Solutions might include simplifying the pathways for pharmacist credentialing and payment, or enforcing health plan requirements to pay.
Bertozzi, who is a professor of Health Policy and Management and former dean at UC Berkeley School of Public Health, has directed HIV and tuberculosis programs at the Bill and Melinda Gates Foundation and held positions at numerous global agencies.
He notes that in June 2025, the Food and Drug Administration (FDA) approved lenacapavir, an injectable drug that provides six months of essentially 100% protection against sexually-acquired HIV infection.
“It’s the most exciting biomedical advance for slowing the HIV pandemic since the announcement of triple antiretroviral therapy at the Vancouver AIDS Conference in 1996,” he said.
“Our efforts are aimed at understanding and removing roadblocks to widespread access to all forms of PrEP, including lenacapavir. We remain optimistic that California pharmacies could play a critical role, just as they did in the roll-out of COVID vaccines Over the coming months we will be issuing a policy brief outlining the policy changes that will need to occur to accelerate the availability of PrEP in pharmacies in California.”
Jonathan Frochtzwajg, the director of health justice policy at the San Francisco AIDS Foundation (SFAF), said that pharmacist-initiated PReP is especially important in communities where vulnerable people don’t regularly see a doctor. He appreciates the work that Hunter and Bertozzi are doing to assess what’s gone wrong.
“They do the deep research that we as advocates and policymakers need to get policymaking right, because the devil of policymaking is in the implementation,” Frochtzwajg said. “If you pass a bill and never look to see if it’s working, you get to pat yourself on the back, but you don’t necessarily do much good.”
“Lauren and Stef have done a lot of evaluation of policies and unfortunately they’ve identified additional gaps that we’re going to take another crack at.”
Protecting Californians from HIV © 2026 by UC Berkeley School of Public Health is licensed under CC BY-NC-ND 4.0
   
Source: https://publichealth.berkeley.edu/articles/spotlight/faculty/research-with-results/protecting-californians-from-hiv
Published by the UC Berkeley School of Public Health. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).
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