We are now waiting for sentencing in the Sean (P. Diddy) Combs trial. Onlookers reading about the trial could have various thoughts. Thoughts about how power corrupts behavior. Thoughts about how men manipulate women through violence and sex. There could be schadenfreude. There could be prurience. Me, I think about HIV preexposure prophylaxis (PrEP).

You heard correctly, PrEP. When I hear testimony about multiple partners and escorts, my concern is for the health of all concerned. This writing is not a speculation regarding the health of Mr. Combs nor his partners. I hope they are well and perhaps they were using PrEP. The individual health of Mr. Combs and his partners is none of my business. But as a specialist in HIV care and a professional medical educator, I cannot ignore this teaching moment, when an event exemplifies what we want the student to learn.

What is PrEP? PrEP is a medication given either as a daily pill or an injection every other month that prevents HIV infection in people at risk for HIV. The cheapest PrEP costs about $45 a month and most insurances pay for it. It is widely available through primary care doctors, student health centers, federally qualified health centers and Planned Parenthood (God bless them). We (still) don’t have a vaccine to prevent HIV infection and the current administration thwarts hopes for a future vaccine by decreasing vaccine research funding and undermining public confidence in vaccines. Fortunately, there are medical interventions beyond condoms that effectively prevent HIV transmission. For instance, the Food and Drug Administration just approved a PrEP injection that will provide six months of protection against HIV infection in people at risk for HIV with sex (anticipated U.S. list price of $28,218 per year).

That said, it would be beneficial to review why the testimony in the trial reminds us of the need for PrEP. There are new HIV infections every day in the United States. While men who have sex with men remain most at risk, heterosexual women comprised 15 percent of new cases in 2022 according to the Centers for Disease Control and Prevention (CDC). Yet less than 10 percent of PrEP users are cisgender women. HIV disproportionally affects African Americans, who comprise under 14 percent of the U.S. population, but about 39 percent of new cases of HIV infection. Only about 14 percent of PrEP users are African American, suggesting there is an unmet need.

There are commercial advertisements for PrEP on television and these messages surely will increase with the FDA approval of the PrEP injection, but it is unclear if the message is getting to the people who need to hear it. According to the CDC, an estimated 1.2 million people in the U.S. could benefit from PrEP. As of 2022, about 36 percent of this eligible population received PrEP prescriptions. Messages promoting PrEP cannot only come from pharmaceutical manufacturers. The medical establishment and government must embrace the concept of harm reduction. However, the president’s proposal to eliminate the CDC HIV prevention program impairs that effort. As a specific example, the current House of Representatives proposal for the One Big Beautiful Bill eliminates future funding for the AIDS Education and Training Centers under the Ryan White Care Act. According to the HIV Medicine Association, preventing just one HIV infection averts more than $500,000 in lifetime health care costs. Given this information, I speculate these cuts are more political acts than cost saving measures.

I commend the bravery of the women testifying in the Combs trial. Ironically, the news contains explicit information regarding the sexual habits of celebrities, but often medical professionals are uncomfortable talking about sex with patients. There is stigma attached to transactional sex (sex for money, drugs, housing). These cultural norms prevent patients from talking to their health care providers about their potential HIV risk and need for PrEP. Whatever the verdict, I hope the media coverage of this trial empowers anyone at risk for HIV, regardless of their gender or race/ethnicity, to talk openly in the doctor’s office to receive the preventive care they need. I also hope our government will not be so shortsighted as to further decrease funding for HIV prevention and education. Such cuts will reverse the progress we have made in controlling HIV infection in the United States.

Catherine Diamond is an infectious disease physician.