For year’s we have commonly associated Joe Biden with activism against brain cancer. As many readers will know- Joe Biden’s son eldest son Beau (a war veteran an Attorney General of Delaware) was killed by brain cancer in 2015.
What few readers will know is- the public health issue championed by his opponent, President Donald Trump. Spectators and commentators alike were shocked when- at the 2018 State of The Union (SOTU) address- the President listed only seven goals, one of which was the elimination of new cases of HIV and AIDs by the end of the decade.
Long past seemed the days when President Bill Clinton would rattle off 30 or more goals of his administration in just one year’s SOTU. Even further passed seemed the days when President Reagan (and the entire Republican Party by extension) was accused of having ignored the emergence of the disease that was then called “GRID”(Gay-Related Immune Deficiency). Research was in order when many pundits wondered openly how the President could possibly pledge to eradicate new cases of HIV and AIDS by 2030 when there was no known cure for either ailment.
Curing (or at least successfully treating) HIV had- for a long time- seemed like the hunt for Osama Bin Laden. A cure was something that had gone on for so long and seemed so impossible that it had almost slipped from public consciousness- save the occasional update on a slow news day.
Upon research, what many were surprised to learn was- the patent on a semi-new drug named PrEP was about to lapse.
To be annoyingly technical, PrEP itself is not a drug- although it is commonly discussed as if it is. PrEP stands for pre-exposure prophylaxis. In simplest terms, PrEP is birth control for HIV. HIV is prevented by taking either Truvada or Descovy.
Among the other benefits PrEP can offer- clinicians have noted that PrEP has benefits for those currently infected with HIV. When used in the right way, PrEP can prevent an HIV infected person from infecting others with the disease.
In emergency settings, when administered at a high enough dose (along with two other drugs), PrEP can serve to intercept HIV infections occurring within the last 72 hours. This process is called PEP (post-exposure prophylaxis), and many consider it comparable in function to the emergency contraceptive Plan-B.
It goes without saying that this drug could mean a lot to those at higher risk of HIV. One in two gay black men will be diagnosed with HIV in their lifetime- one in four gay Hispanic men will be diagnosed the same way. One in Forty Eight black women of all sexualities will face an HIV diagnosis in their lifetime. The recent spike in intravenous drug use that affects all classes and strata of society has been increasingly cited by medical experts as causing a sharp uptick in HIV cases in all communities. The Deep South, as well as several other geographic regions in the United States, have been particular hotbeds for new cases of HIV irrespective of sexual preference, age or a preferred sexual position.
Despite the invaluable effects, PrEP drugs could provide to numerous communities, access to the drugs has been limited- due mostly to their prohibitive costs.
Those seeking PrEP have seen the double-edged sword of American healthcare. America was the first country to have PrEP hit the market. PrEP entered the market in 2012, 6 years before other nations. Many nations- including many western nations, still do not have PrEP available to the public. It must be noted that countless lives were saved in the US by the early introduction of PrEP to key communities. Likely, there are people alive today in America who would not otherwise be alive because of the early introduction of PrEP.
However, that early introduction has a price. Without insurance, prices for PrEP can cost as much as $2,200 a month. At this price point, very few can afford the drugs without some sort of private assistance program (which is incredibly rare and usually not available to all people). Some federal programs have tried to aid those seeking prescriptions for PrEP, but these have their own red-tape barriers. For these reasons and others, access to PrEP has remained limited to an exclusive few.
In an EXTREMELY rare move, the Trump administration ordered a federal lawsuit against Gilead- the singular manufacturer of both Truvada and Descovy. Historically speaking, the federal government rarely takes on disputes with drug manufacturers.
As The New York Times reported in 2019,
“It is very rare for the government to take on a drug maker over patents. But the medications made by Gilead are necessary to end the AIDS epidemic by 2030, which the Trump administration has set as a goal. That cannot be accomplished if the drugs are not made more affordable.”
Using a series of legal technicalities involving questions related to patent law, the administration attorney’s defeated Gilead in court. The Ninth Circuit held for the Trump Administration, and the Supreme Court of the United States refused further appeal.
At the beginning of this week, the patent on Descovy and Truvada expired.
What Does This Mean?
The patent’s expiration means that generic versions of Truvada and Descovy will enter the market in coming days. As a general rule, generics slash prices in the market. As Federal Trade Commission Working Paper 317 cites, adding just two generic competitors to the market can reduce name-brand drug prices by as much as 22%. In the case of just three competitors entering the market, drug prices can fall almost as much as 55%.
Serious action is already being taken to introduce competitors. Teva Pharmaceuticals is widely expected to introduce a form of PrEP into the market by year’s end- other drug producers are expected to soon follow.
A Future Without Fear
Most gay men can probably tell you of the constant fear HIV poses. Even the most careful of gay men still worry. Many can recall to you the stomach-churning fear of buying that $45 test at home test from Walmart- or sitting in a long line at the free-clinic to get anonymous testing.
In recent years, the burden of HIV has shifted away from the gay community. The black communities have seen a disproportionate amount of new infections and fatalities from the affliction.
Public figures of all sexual persuasions and races have been killed by HIV and AIDs, singer Freddy Mercury, attorney Roy Cohn, artist Kieth Haring, rapper Easy-E, and congressmen Stewart McKinney are just to name a few.
Occupationally, HIV infection is a particular fear and danger to those in the medical community. Every medical professional knows the danger of an accident potentially creating an HIV infection. The EMT who attempted to save Mathew Shepard and tore their last glove in the process- was exposed to HIV clearing blood from his airways. At that time- there was nothing to be done for medical professionals who were exposed. They had to simply undergo constant monitoring, take leave from work and pray. (Miraculously, the EMT in the Shepard case was eventually discovered to be fine and without infection).
Among experts there is great disagreement about whether new cases of HIV and AIDs can truly be eliminated by 2030. Skeptics usually point to cases of poor distribution and mismanagement as cautionary tales. However, in the past when the government and private sector have united in concerted efforts to eradicate diseases like polio, mumps and rubella, a marvelous symbiosis forms that allows both to achieve a common goal.
No matter what happens by 2030- for the first time since the emergence of GRID it is not unreasonable to for those in the gay, black and medical communities (as well as others) to have hope of a future without fear of HIV.