Op-Ed: Texas Must Act to Ensure Access to Life-Changing HIV Treatment for All
State refuses to cover Cabenuva, a life-changing injectable HIV medication, for low-income residents.
by Emmett Schelling and Atlantis Narcisse
Texas stands at a critical crossroads in HIV treatment. Right now, there are 105,365 people living with HIV in our state, and the number of transgender Texans living with HIV grew by an astonishing 60% between 2014 and 2018. We must address a glaring healthcare inequity: the lack of access to long-acting injectable HIV treatments for uninsured or under-insured Texans living with HIV.
Remarkable scientific advancements in the last twenty years have made HIV a treatable and preventable disease. And yet despite these innovations, significant disparities persist in public awareness and access. Trans and non-binary people in particular face social and structural factors like discrimination in health care and housing, and economic insecurity that can make it difficult to access health care and HIV treatment.
An innovative injectable HIV medication called Cabenuva represents a breakthrough in HIV treatment. Recent data from February 2024 shows that Cabenuva is actually more effective than daily medication in maintaining viral load suppression, a crucial marker of health for a person living with HIV. For the same reason that birth control options include both daily medications and long-acting devices, it makes sense to have long-acting HIV treatment options available to all patients.
As community leaders, we hear from people living with HIV about the profound benefit of long-acting injectable treatment. One person, Michael Elizabeth, from Houston, told us that switching to monthly injections for HIV treatment “has totally changed my life. Now I am confident in my treatment plan and it’s given me the ability to take care of myself beyond my status. I want every Texan living with HIV to be afforded the same freedom to take control of their health and improve their quality of life.”
Yet, Texas remains one of only 8 states nationwide refusing to cover this life-changing medication for low-income residents. In Harris County alone, a significant portion of people are denied access. This is not just an administrative oversight—it’s a profound failure that directly impacts the most vulnerable members of our community.
The state’s failure to offer all treatment options to all Texans living with HIV sends patients a damning message: my life is not as valuable. Not only that, we can see in data for patients on the Texas HIV Medication Program (THMP) that their viral suppression is worse than patients with other insurance. Denying patients’ access to breakthrough treatment is harming their health.
Texas Department of State Health Services’ current policy disproportionately impacts our most vulnerable communities. While Medicaid and private insurers cover Cabenuva, THMP patients are left behind. This is a public health problem. For instance, injectable treatment is likely to be a much better fit for people dealing with housing insecurity or mental health challenges– some of the most vulnerable people in our communities.
Research shows long-acting injectable treatments can significantly improve viral suppression and patient outcomes. By refusing to offer Cabenuva for almost four years, Texas is denying community members living with HIV the ability to achieve better health outcomes. And trans community members and people living with HIV are making their voices heard and asking for a solution.
Every Texan living with HIV deserves access to effective, comprehensive medical care, regardless of their insurance type or economic status. And the decision about which medication is most conducive to health and well-being should belong solely to patients and doctors—not insurance providers.
As transgender community leaders living in the Houston area, we urge our leaders to immediately offer Cabenuva to low-income Texans. It’s past time to ensure that no Texan is left behind on our journey toward ending the HIV epidemic.
Emmett Schelling is Executive Director, and Atlantis Narcisse is Director of Programs at Transgender Education Network of Texas.
