As COVID-19 continues to spike across the globe, the international community mentioned World AIDS Day on 1 December, calling attention to another deadly pandemic that has yet to be curbed. According to UNAIDS, AIDS (HIV) has claimed the lives of an estimated 32.7 million people since the pandemic’s outbreak, and despite there being effective treatments to combat the disease, the virus continues to infect over a million people each year and cause hundreds of thousands of deaths.
As World AIDS Day headlines tumble further down our feeds and the bombastic statements made by politicians pledging to tackle the virus are usurped by other agendas, it is important to take a close look at the current state of the AIDS pandemic, the systemic inequities it highlights, and our governments’ handling of the crisis in order to draw conclusions that will not only help staunch its spread but also assist us in mitigating the scourge of COVID-19 and any future pandemic.
Despite the overall decrease in the spread of HIV and the plummet in mortality rates from the virus (60 per cent since the 2004 peak), the HIV pandemic remains a global health threat to this day. A World AIDS Day statement by the World Health Organisation (WHO) has confirmed that in 2019, 38 million people worldwide still lived with HIV infection, 690,000 people died of HIV-related complications, and 1.7 million were newly infected. WHO further reports that one in five people in 2019 were not aware of their infection and one in three, particularly children and adolescents, experienced some form of disruption in HIV treatment, testing, and prevention services.
Since its outbreak, the HIV pandemic has disproportionately affected the LGBTQ community. According to the Centers for Disease Control and Prevention (CDC), more than 50 per cent of people living with HIV in the US are gay and bisexual men, and a WHO study from 2014 had estimated that trans women are 49 times more likely to be diagnosed with HIV than the rest of the population. Within the community, and across the country as a whole, it is people of colour (specifically black people) who are the most vulnerable to the disease. A 2016 CDC report had found that at the current rate of infection, one in two queer black men and one in four queer Latino men are projected to contract HIV in their lifetime.
The advent of COVID-19 in early 2020 has exacerbated an already difficult situation for people living with or at risk of contracting HIV, as coronavirus has presented increased health threats for people living with the virus and has lead to significant disruptions in provision of HIV-related services, drug stock-outs, and shortages of supplies.
“There is some evidence that people living with HIV may have an increased risk of severe disease and death from COVID-19,” said Tedros Adhanom Ghebreyesus, the head of WHO, in a statement last week. “This increased risk has been compounded by disruptions to treatment for people living with HIV. In a WHO survey of 127 countries earlier this year, more than a quarter reported partial disruption to antiretroviral treatment for people with HIV.”
The widely-anticipated COVID-19 vaccines have filled many with hope that the nightmare of coronavirus will soon be behind as. But as the history of the HIV pandemic demonstrates, when it comes to the populations most vulnerable to the virus, the christening of a new vaccine or drug may not provide significant relief.
“[A] pharmacological intervention alone is not going to get us out of the death and destruction we’re seeing,” said Steven W. Thrasher, professor at the Medill School of Journalism at Northwestern University, in an interview for Democracy Now! on World AIDS Day, referring to both the HIV and COVID-19 pandemics. “There have been various effective medications for HIV for the past quarter of century, and yet tens of millions of people have died since that time,” he further stated, pointing to the fact that in 2015, 20 years after antiretroviral therapy (ART) has been introduced, AIDS rates among black Americans were higher than they had ever been among white Americans before the drugs existed.
“The problem is not just the drugs; it’s the conditions around people’s lives that lead them to become affected by viruses,” Thrasher added, stating that it is the byproducts of capitalism—namely the profit-driven and pharma industry-dominated healthcare infrastructure—and systemic racism that render communities of colour more vulnerable to pandemics and concentrate diseases among certain segments of the population.
Thrasher further cited a November 2020 study that links high eviction rates to increasing deaths from COVID-19, and explained how houselessness (a crisis disproportionately affecting people of colour) makes minority groups more susceptible to contracting viral diseases by siphoning them out of the formal economy, forcing them to live in over-crowded communities, exposing them to sexual abuse, and depriving them of insurance and proper access to healthcare services. Thrasher also iterated that while COVID-19 and HIV are transmitted differently, there is nonetheless great overlap in the conditions that make specific populations vulnerable to them.
While President Trump has repeatedly ignored the havoc wreaked by HIV on the queer community, and has actively inhibited progress in HIV treatment and prevention efforts, president-elect Biden has been vocal about his intention to tackle the virus and help those most affected by it, indicating a potential shift in federal conduct around the pandemic.
In a statement on World AIDS Day, Biden declared that his administration “[w]ill pursue bold solutions and increase our collaboration with affected communities around the globe,” as reported by the Washington Blade. “We will redouble our efforts to tackle health inequities that impact communities of color, LGBTQ+ people, and other marginalized groups, including women and children,” he added.
Biden’s statement last week was in line with a plan he had unveiled in 2019 to advance LGBTQ+ equality, which includes tackling the HIV pandemic globally. In his recent statement, Biden has also pledged to increase funding for several key federal programs designed to battle HIV, including a program that seeks to increase housing opportunities for people living with the disease.
As we grapple with the complex reality of overlapping viral outbreaks, it is important that we remain conscious of the underlying conditions that breed mass health inequities and pressure our leaders to not only deliver crowd-pleasing statements but tackle the core issues that enable such pandemics to spread and ravage society’s most vulnerable communities.
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Ever since Truvada has been approved as pre-exposure prophylaxis (PrEP), meaning the use of antiviral drugs as a strategy for the prevention of HIV, it has gained increasing popularity across the globe—from the U.S. to Britain to Taiwan—and has been hailed as the ultimate method to combat the HIV epidemic and prevent new infections. For the past few years, criticism of the manufacturer and distributor of Truvada, Gilead Sciences, has remained relatively mild and did not slow down the surge of its products’ proliferation.
A recent lawsuit, however, filed by 41 Truvada patients who claim to have suffered damage to their kidneys and bones as a result of the drug, seeks to hold the California-based Gilead accountable and casts doubt over the company’s ability to continue its operations unimpeded.
The 41 plaintiffs, who come from 12 different states, have been using the Truvada either for HIV treatment in the form of tenofovir disoproxil fumarate (TDF) or as a preventative measure through the PrEP medication. All of them have sustained kidney damage and/or bone density loss upon sticking to a daily regimen of Truvada.
The lawsuit, launched by HIV Litigation Attorneys and funded by the AIDS Healthcare Foundation (AHF), was filed in the Superior Court of the State of California for the County of Los Angeles. On the firm’s website, HIV Litigation Attorneys declare they seek to hold Gilead accountable for its “failure to adequately warn about Truvada side effects, marketing a drug with design defects and stalling the development of a safer version of the HIV treatment in order to maximize profits”.
The severe and highly-dangerous side-effects associated with a fixed-dose administration of Truvada have been known to Gilead since 2001. Yet, while the company issued repeated warnings about Truvada’s side-effects in the EU, it omitted such information from its prescriber and patient labelling in the U.S. All the while, Gilead has been actively suppressing a safer alternative it developed to TDF, tenofovir alafenamide (TAF), in order to maximize profits off of TDF.
“We need to make sure pharmaceutical companies take patient health and safety into consideration in its business decisions”, Liza Brereton, attorney for the plaintiffs at HIV Litigation Attorneys and counsel for AHF, told Screen Shot, “You would think they always do this, but far too often, big pharma makes decisions to maximise profits over ensuring access to the best medications”.
Gilead’s profiting off of Truvada has come under scrutiny long before the lawsuit was filed, particularly since the funding for its research relied on $50 million of taxpayers’ money. According to the Washington Post, in 2018 alone Gilead raked in $3 billion in sales from Truvada. Averaging at $1,600 to $2,000 a month if taken daily, Truvada remains unaffordable to a great number of Americans who are either uninsured or whose insurance plan does not cover the drug. Truvada’s prohibitive cost has meant it was least accessible to some members of the Black and Latinx queer community, despite the fact that the HIV epidemic concentrates primarily in their communities.
Commenting on the law firm’s agenda with its lawsuit, Brereton stated that, “In addition to fully compensating people who have been injured by Gilead’s decision to release the inferior TDF-drugs over the TAF-drugs, we would like Gilead to allow production of generics of its TAF-based drugs, which should have been released to the public years ago. Branded TAF is too expensive and Gilead should not be able to profit off this decision that hurt patient health”.
This begs the question—in lieu of safe medication available on the market, how can we continue to promote HIV prevention, both in our communities and on a large scale?
“Condoms are an effective way to promote HIV prevention and prevent the spread of STDs”, says Brereton, “ No HIV prevention drug prevents other STDs and no drug on the market is safe for long term consumption as a prevention mechanism. Keep in mind even Truvada as PrEP was approved by the FDA for use in combination with condoms”.
Brereton adds that “Gilead should have investigated and studied TAF as a preventative many years ago. They should get that done to see if it is effective as an HIV preventative because it is safer for patients’ kidneys and bones than TDF”. If we were to take a closer look, however, we would realise that the problem isn’t only Gilead’s unscrupulousness, but the fact that we look for a pill to solve an extremely complex and multi-layered issue.
There is no doubt that Gilead must be held accountable for its criminal and reckless behaviour—something that would hopefully set a precedent for other big-pharmas as well. Yet, in order to truly eviscerate the HIV epidemic, we must first address core issues such as systemic racism, queerphobia, economic disparities, and unequal access to quality education, housing, and healthcare.
It seems that by relying exclusively on medicinal solutions, we search for a quick fix for a problem that permeates all aspects of our society, one that would require extensive structural, social, and political overhauls to be rectified.