In recent years, local health officials have reported a significant decline in HIV prevalence. With new yearly cases dropping below the 200 mark, the lowest recorded since the 1990s, the District counts among the forerunners of national efforts to end HIV as a public health threat.
As Valerie Rochester explained, meeting that goal requires continuous focus on a population most at risk of contracting HIV.
“Black women still continue to be the highest, the fastest growing group of women who are being diagnosed with HIV as far as new infections,” said Rochester, executive director of The Women’s Collective. “We just have to keep doing what we’re doing. Talking about it, informing the public about the importance of HIV testing, and knowing one’s status.”
The Women’s Collective was founded in 1992 by Patricia Nalls, an HIV-positive woman who initially launched the organization as a phone support line for women and girls living with HIV and at risk of contracting the virus. More than three decades into its existence, The Women’s Collective continues to offer a variety of services, including: medical case management; street outreach and HIV/Hepatitis C testing; connection to Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) care; and provision of personal care products.
Rochester said that, every week, up to 40 women visit The Women’s Collective’s headquarters near New York Avenue and Bladensburg Road in Northeast in search of such services. Amid the Trump administration’s decimation of Centers for Disease Control and Prevention HIV programming, and the D.C. Council’s recent efforts to knock down barriers to PrEP and PEP, The Women’s Collective is hosting weekly support groups where women between the ages of 18 and 80 inquire about ongoing developments.
“The women that we serve actually came to us with questions about how the prevention opportunities and prevention services would be able to continue,” Rochester told The Informer. “We’ve had regular conversations with our clients in the support groups and others.”
Although Congress averted a crisis in February with the passage of a Fiscal Year 2026 budget that, despite Republicans’ best efforts, sustains funding for most federal HIV prevention programs, Rochester said she’s not keeping her eye off of the eight ball.
In recent months, The Women’s Collective has joined local and national advocacy groups in emphasizing the importance of HIV prevention. They’ve done so while case workers continue to maintain a presence in zip codes with high levels of HIV prevalence and substance use disorder. As Black women, and other at-risk populations, face hurdles in accessing PrEP and PEP, The Women’s Collective is also allaying concerns about medication and enrolling clients in its case management system.
Rochester said the work goes on, no matter what.
“We’re all worried that if this attack on prevention funding continues and funding decreases, there’s a very strong likelihood that we are going to start seeing the numbers start to creep back up,” she told The Informer. “That’s one of the reasons why we and others are continuing with the education around the importance of PrEP, making sure people know it is still available [and] this is a critical tool in ensuring that those numbers continue to go down.”
PrEP reduces one’s risk of contracting HIV by 99% when taken regularly during a time span of one to three weeks. This ensures maximum protection against HIV after anal sex, receptive vaginal sex, and injection drug use. PEP, also known as Post-Exposure Prophylaxis, must be taken every day after potential HIV exposure. Physicians say that patients have the best chance of circumventing HIV when their PEP regimen starts within 12 to 24 hours of the inciting moment, and continues regularly throughout a 28-day period.
Last year, the U.S. Food and Drug Administration (FDA) approved twice-yearly injectables. That advancement, the global rollout of which is hampered by Trump administration funding cuts, happened four years after the entry of once-every-two-month injectables into the market.
While generic brands of PrEP and PEP are usually easier to obtain from some physicians, Rochester said Black women who’ve attempted to access branded prescription medication face insurance hurdles via cost sharing and prior authorization. Despite requirements in the Affordable Care Act that private and public insurance plans cover PrEP medication related clinic visits, and lab tests without deductibles, insurers utilize prior authorization, perhaps to compel use of generic brands.
That’s why she extolled the D.C. Council for its passage of the PrEP DC Amendment Act.
“This is one of those things that holds a lot of potential as far as dismantling another one of those barriers that individuals may have as far as cost is concerned,” Rochester said. “It’s making sure that there is that enhanced or increased access available for PrEP services so that cost should never be a factor in anybody’s ability to seek any kind of care or treatment.”
The Promise of Some Relief in 2027
On March 3, the D.C. Council unanimously approved the PrEP DC Amendment Act on its second reading. The legislation, introduced by D.C. Councilmember Zachary Parker (D-Ward 5), includes elements of D.C. Councilmember Brooke Pinto’s bill, Removing Barriers and Reducing Stigma to Encourage HIV Prevention Amendment Act of 2025.
The PrEP DC Amendment Act prohibits health insurance companies from using prescription information for HIV prevention treatment to increase premiums for certain enrollees. It also stops insurers from imposing cost sharing, prior authorization and restrictions deemed medically unnecessary for coverage of HIV prevention services and federally-approved PEP and PrEP formulations.
“This bill is more than access to medicine,” Parker said during the council’s Feb. 3 legislative meeting. “It is also about affirming the humanity of LGBTQ people confronting stigma with action and embedding these protections that are now recorded in the Affordable Care Act in local law.”
During that legislative meeting, council members approved amendments that Parker and D.C. Councilmember Christina Henderson (I-At large) introduced to: ensure the District maintains coverage requirements in alignment with 2024 federal guidance while allowing for future formulas deemed safe by the FDA; clarify that insurers cannot impose cost sharing for either initial or follow-up appointments; and strike a redundantly prohibitive phrase from the definition of “medically unnecessary restrictions.”
“The reason why that is important,” Parker continued in his remarks, “is because we know there are routine efforts to undermine Obamacare or the Affordable Care Act at the federal level and we are safeguarding these protections here locally for District residents.”
During the latter part of 2025, Whitman-Walker Medical Clinic DC counted among eight organizations that testified before the D.C. Council’s Committee on Health in support of the PrEP DC Amendment Act. As the first quarter of 2026 wraps up, staffers are still calling insurance companies in response to the influx of prior authorization and cost-sharing prompts for prophylaxis.
That’s why Dr. Kyle Benda said that he’s looking forward to seeing Parker’s legislation come into effect.
“I don’t have a reason why more insurances are requiring prior authorization,” said Benda, medical director at Whitman-Walker Health at 1525, located near Logan Circle in Northwest. “But I do know that with the new enactment starting in 2027…they won’t be able to create prior authorization burdens when patients are seeking PEP services, and that is going to be a really, really important factor in just taking some of the pressure off an already stressful situation.”
Whitman-Walker, a provider of inclusive, community-based primary health care predominantly frequented by HIV-positive D.C. residents and members of the LGBTQ community, has nearly 30 staff members who are prepared to provide PrEP and PEP. Amid federal spending cuts, the clinic continues to seek grants while clinical and non-clinical team members collaborate via PrEP navigator programs to help clients maintain their prophylaxis regimen.
Benda, who’s in his fourth year at Whitman-Walker as a staff physician, says that, even as the stigma around HIV wanes, there remains the issue of ensuring that community members can access prophylaxis in a timely fashion.
He told The Informer that insurance matters often complicate that mission.
“We’ve seen an increase in the amount of prior authorizations needed for app services and then some more prior authorizations needed for our long-acting injectables for PrEP,” said. “There’s been some changes to coverage for some folks when it comes to some of the public benefits provided by D.C. that have changed a few ways that….there’s been coverage for certain medications.”
After a budget deliberation cycle that resulted in the narrowing of public health benefits, getting coverage for PrEP and PEP has become an even more confusing endeavor.
“Many patients don’t know what their insurance covers and what they don’t. Also, many providers don’t know what specific insurance plans will cover and what they won’t,” Benda told The Informer. “We often don’t find that out until we try a prescription. Certainly, insurance barriers or needing to navigate the insurance approval process can take a significant amount of time and administrative burden and can delay initiation of PrEP.”
Other provisions of the PrEP DC Amendment Act aim to prevent insurance provider discrimination against users of HIV prescribed treatment and establish the DC Health and Wellness Center Fund, which creates a revenue stream for the provision of free and low-cost HIV prevention services.
As Henderson’s office explained, more steps are in the queue to ensure that, come 2027, insurance companies follow suit.
“D.C. Department of Insurance, Securities and Banking (DISB) will finalize requirements for all District health care plans in May 2026 for plan year 2027,” a staffer wrote The Informer in an email. “It was important for the council to approve the bill before May for DISB to incorporate into 2027 plans. DISB has indicated they plan to incorporate the new requirements into 2027 plans.”
Allies Weather the Storm of Funding Gaps
Jeffrey D. Richard, a longtime organizational leadership consultant, told The Informer that the council’s passage of the PrEP DC Amendment Act comes at a harrowing time for some of the District’s most marginalized.
“Right now, there often is anywhere from three to four months where some people do not actually have co-pay assistance [and] can’t afford the PrEP co-pay,” Richardson said. “So they’re not taking it seven days a week with fidelity.”
Richardson currently serves as managing director of Damien Ministries, a nonprofit that partners with DC Health in HIV testing and treatment. Some of that work takes place at Restoration Station, a space on Minnesota Avenue NE that Damien Ministries sponsors and makes available to other local nonprofits and organizations.
Offerings provided by Damien Ministries include: rapid HIV/ Hepatitis C testing; nutrition, coaching and counseling, an emergency food bank, and boutique clothing assistance. Amid the nonprofit’s potential launch of a wellness hub near Restoration Station where service providers lacking a brick-and-mortar space can help Medicaid and Medicare patients, Richardson called the council’s recent move a potential game changer.
“We not only go from being able to make PrEP available via Medicaid, but now we also have the six-month injectable, which increases efficacy,” Richardson said, “People people aren’t taking the pill every day. If they don’t take the whole seven days, it diminishes its fidelity and ability to work.”
Such developments, Richardson said, will help Damien Ministries further advance its mission.
“We have a lot of unhoused and frequently homeless populations that we want to introduce the six-month injectable,” Richardson told The Informer. “The fact that [the legislation] and the work being done is going to have that be fully covered under Medicaid is huge. It’s going to…allow us to get more people, in particular women and Black women, which the injectable is also being highly encouraged for, have access.”
At its inception nearly 40 years ago, Damien Ministries served a client base that almost exclusively included Black and brown gay men and members of the trans community. In recent years, however, amid the uptick in HIV infections among older cisgender Black women, Damien Ministries has collaborated with The Women’s Collective and other local entities.
Throughout much of the second Trump administration however, much of Damien Ministries’ work, and that of its partners, has been threatened by federal funding cuts. For one, DC Health no longer doles out free condoms. Damien Ministries also lost significant funding last summer for Americorps volunteers who conducted rapid testing, outreach and education.
“Since May, we haven’t been able to support those volunteers doing that work,” Richardson said, “so at the current moment, we’re a bit reduced in our capacity to do that outreach and prevention.”
Other casualties of the federal funding rollback include a workforce grant that allowed young people experiencing housing discrimination to serve as outreach workers. Richardson and his colleagues have since adjusted their strategy, using their accumulation of knowledge and Damien Ministries’ rapport as leverage.
“We still partner with organizations and often come in and do some testing,” Richardson noted, “and … a bit more training [in rapid testing and health screening] for organizations who have staff volunteers.”
In the midst of a funding gap, Damien Ministries is exploring other options — but not without issue.
“It’s a bit of a challenge in finding funding that’s focused on program implementation, service delivery, because that’s what government funding really has historically gone to,” Richardson told The Informer. “We’re definitely trying to find foundation dollars and partnerships that will invest back into those direct services…so we can get people back on the street.”