The first case of HIV/AIDS in the United States was reported on June 5, 1981. Since then, over 690,000 people have died of AIDS-related illnesses in the United States. Many believe the HIV/AIDS Epidemic is behind us, but currently, 1.1 million people in the United States are living with HIV, and approximately 3,900 of those live in Raleigh.
On July 16, 2012, the U.S. Food and Drug Administration approved Truvada as a drug to be used for pre-exposure prophylaxis (PrEP). PrEP is a treatment for individuals who do not yet have HIV but are at a high risk of contracting the disease. If PrEP is taken as directed, it has been shown to reduce the risk of contracting HIV by 92-99%.
PrEP is incredibly effective at preventing the contraction of HIV; however, as of 2016, only 77,120 Americans were using PrEP, which is less than 10% of the population estimated by the CDC as being at “high risk” for contracting HIV. This could be because the average cost of PrEP is $1,989.57 per month. Gilead, the company that produces Truvada, misleadingly advertises that patients could pay as little as $0 to receive a PrEP prescription if they have health insurance or if they qualify for medication assistance programs; however, this does not apply to everyone. In fact, around 150,000 North Carolinians are uninsured.
Truvada is currently the only PrEP drug on the market, and their patent does not end until 2020. This means that a generic form of PrEP will not be available until at least 2020, and prices are not likely to drop much until several brands are on the market to increase competition.
During his second State of the Union Address, Donald Trump announced his plan to end the HIV epidemic by 2030, in part by encouraging the use of PrEP. At its current price point, this is not a reasonable goal considering 58% of Americans have less than $1,000 saved.
The price of PrEP is a slap in the face to groups which have historically been disproportionately affected by the AIDS crisis, including LGBTQ+ individuals, people of color, people who regularly use injectable drugs and those living at or below the poverty line.
According to patent law, the U.S. government has the right to “march in” and break a patent if it provided funding that led to the product’s development and if there is a public security risk the company that holds the patent cannot handle. The HIV/AIDS crisis is, in every way, a public security threat.
The Centers for Disease Control and Prevention (CDC) holds patents for the generic form of Truvada but refuses to take action toward reducing the price of PrEP. This could be because they do not want to interfere with a major pharmaceutical company like Gilead, they are being paid under the table or they just do not care about the communities most affected by HIV/AIDS. Regardless of their reasoning, inaction is unethical and directly contradicts their mission and pledge to the American people.
The U.S. government has an obligation to take advantage of these march-in laws and fight the crisis they have historically ignored because it affects people they did not find desirable. The current price of PrEP is not only allowing this crisis to continue but exacerbating it by punishing high-risk individuals who can’t afford this overpriced but necessary drug.
NC State provides confidential HIV and STI testing at the Student Health Center and provides information about free off-campus testing locations. Testing is available in both the Primary Care and Women’s Health clinics. PrEP is available by prescription through the campus pharmacy.
NC State must do a better job of advertising the benefits and availability of HIV testing and PrEP for students’ health and safety. However, this will not be truly effective until the price of PrEP is made attainable for all.