Anti-HIV PrEP remains $2000/month in the US, two years on from generic FDA approval. In Cuba it’s now free.

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In March 2019 Cuba began a pilot scheme to supply the only effective HIV prevention drug PrEP (pre-exposure prophylactic) free of charge to those in need. Following on from their successful 2015 drive to completely eradicate HIV and syphilis transmission in utero, Cuba’s National Centre for Sex Education began a program in conjunction with the Pan-American Health Organisation (PAHO) to distribute the drug for free.

Although available to all Cubans, in its first stage the scheme is currently only operating out of Center for Prevention and Control of STIs, HIV, and AIDS in Cárdenas, in the province of Mantanzas – home to over half of all HIV-positive Cubans. It will likely expand across the country through Cuba’s system of rural polyclinics if successful.

In contrast, the drug combination Emtricitabine/Tenofovir, marketed as Truvada in the United States, still costs $2000 a month for Americans, largely out of pocket for non-insured citizens. This represents over 50% of personal income in Georgia, the state with the highest HIV transmission rate according to 2018 census data. Over 15% of Georgians were uninsured in 2017, the majority of them African-American: a group disproportionately likely to contract HIV.

The cynicism of obscene price gouging on behalf of US patent holder Gilead Sciences is compounded by the existence of a legal generic version of the drug approved in 2017. There is a legal settlement reached between Gilead and Teva to produce and distribute the drug but Teva currently aren’t selling them, almost certainly owing to a confidential ‘pay-to-delay’ agreement between the two Pharma giants. Brandon Brown, assistant professor and HIV expert at the University of California Riverside, told the website Healthline that ‘there may be some confidential agreements between the manufacturer of Truvada and the manufacturer of generic PrEP, which include delaying the release of this new product’.

To put it crudely, Gilead are scraping as much profit from the bottom of the barrel of their patent, and are sending a cut to potential producers of cheaper generics. This lack of mercy is how CEO Daniel O’Day creates over $22 billion in revenue each year for his company and takes home a salary of $31 million.

To add further insult, various groups that advocate breaking the patent have also highlighted that much of the research into Truvada was actually funded by the US Federal government. ‘Gilead Sciences charged over $2,000 a month for a drug that costs them less than $6 a month to make, and whose research was funded entirely by the federal government and other charities,’ Christian Urrutia, co-founder of the PrEP4All Collaboration summarised to LGBTQNation.

Care without Capital.

Thanks primarily to biting American sanctions and the collapse of their Soviet partner state in the 90s, the Cuban economy is undoubtedly disastrous. But from the scraps of a Mickey Mouse economy they have manufactured a ‘shining example’ of accessible healthcare according to US NGO the Kaiser Foundation, which Kofi Annan believed ‘demonstrates how much nations can do with the resources they have if they focus on the right priorities’.

The island, just 90 miles away from the coast of Florida, serves as a slightly rude testament to the paltry ambition of its American nemesis, the largest economy in the world which still has no public healthcare system. In the 1960s life expectancy of Cubans grew by almost nine years as the new Socialist system was implemented; according to the World Health organisation female life expectancy surpassed 80 years by 2016.

Cuba has one clear advantage: without any aspect of their system bent on profiteering, long-term preventative and educational measures can take the place of expensive pharmaceutical consumption. North America accounts for half of the $21 billion HIV treatment drug market despite fewer than 5% of the global HIV-positive population residing there, but transmission rates still remain very high in the US compared to other Western countries. The architecture of the American pharmaceutical-industrial complex simply isn’t geared towards slaying its cash cow by expediently eradicating illness.

Despite being a Marxist-Leninist command economy, the Cuban healthcare system is remarkably personal and decentralised. After the WHO Declaration of Alma Ata in 1978, Cuba began to implement a system of ‘community-based polycentres’ which are handed serious autonomy over the services they provide. This program has provided very targeted and pre-emptive community medical services to 95% of Cubans, many of whom are desperately poor.

These centres have become the backbone of community-focused healthcare schemes, from the mass vaccinations of the 1990s to the sex education schemes of today that are obliterating STIs at an astonishing pace.

If you remove profit and put human beings at the epicentre of the system, it’s remarkable how much can be achieved on a shoestring budget. Imagine what the US could do for its own citizens, owning the biscuit rather than the crumbs.

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Ruairi Wood

English Dirtbag. Read the Bread Book, Google Murray Bookchin. amityunderground@protonmail.com