On July 3, 1981, this newspaper wrote about a “rare cancer” killing gay men in New York and California. Though few knew it, what followed would be a generation-defining battle: for attention, for legitimacy, for our very lives. Today, after 37 years, we finally have a proven pathway to ending the AIDS epidemic in this country.
The only catch? Poor policy and pharmaceutical price-gouging have blocked the way, making critical drugs a luxury rather than an imperative.
The solution comes in a pill: Taken daily, Truvada, the brand name for a type of pre-exposure prophylaxis, or PrEP, is up to 99 percent effective at preventing H.I.V. infection. Used as directed, it’s one of the most effective methods of preventing a viral infection ever discovered, as good as the polio vaccine, the miracle of modern medicine. When you combine PrEP’s effectiveness with the discovery that people living with H.I.V. cannot transmit the virus to others once they become undetectable, we could be on the verge of a swift end to the epidemic.
Truvada was approved by the Food and Drug Administration in 2012. But over six years later, the United States is failing miserably in expanding its use. Less than 10 percent of the 1.2 million Americans who might benefit from PrEP are actually getting it. The major reason is quite clear: pricing. With a list price over $20,000 a year, Truvada, the only PrEP drug available in the United States, is simply too expensive to become the public health tool it should be.
Gilead Sciences, the company that makes Truvada, maintains a monopoly on the drug domestically. In other countries, a one-month supply of generic Truvada costs less than $6, but Gilead charges Americans, on average, more than $1,600, a markup from the generic of 25,000 percent.
Infuriatingly, American taxpayers and private charities — not Gilead — paid for almost all of the clinical research used to develop Truvada as PrEP. Yet the price stays out of reach for millions, and will for at least several more years.
The disparities in PrEP access are astounding: Its use in black and Hispanic populations is a small fraction of that among whites. In the South, where a majority of H.I.V. infections occur, use is half what it is in the Northeast. Women use PrEP at drastically lower rates than men, and while there’s no national data on PrEP and transgender Americans, it’s almost certainly underused. The issue of PrEP access has become an issue of privilege.
But hey, what is more important in New Gilded Age health care than very rich people making even more money? Actually, I know the answer–it’s taxpayers funding the research that rich people make even more profit from and terrible racial and gendered disparities.